2009-2010 NTMA Program Registration Form


Classes fo the 2008-2009 school year are already in progress.If you are interested in 2009-2010, We are accepting applications . After receipt of your registration form, addtional details, including class times, will be mailed to you in August 2009. If you have any questions, please feel free to call (866) 326-6862 for more information.

All fields marked with an * are required.
Personal Information
Name*
Home Address*
City*
State*   
Zip Code*
Home Phone*
Cell Phone
Work Phone
E-Mail Address*
Birth Date* (mm) (dd) (yyyy)
Gender* Male Female
How did you hear about the NTMA Apprenticeship Program?

My Company I was referred by an Individual

I was referred by an Organization I saw an Ad

Please tell us where you saw the ad or who referred you:
Employment Information
Please complete the following information
in regard to your current employer or company.
Employer/
Company Name
Employer/
Company Address
City
State   
Zip Code
Employer/
Company Phone
Employer/
Company Fax
Company Website
Company Contact's Name
Contact's E-Mail Address
Company Contact's Position
Is Employer/Company an
NTMA Member Company? 		Yes No
Length of Employment from (mm) (yyyy)
to      (mm) (yyyy)
Position Held
Hourly Rate
If you are NOT currently working in manufacturing,
please indicate which of the following applies:
Dislocated Worker Laid Off Unemployed Other
Training Information
Year of Apprenticeship you are entering* 
1 2 3 4
Do you want to take advanced placement
testing for the year indicated above?*
 (NOTE: There is a fee associated with taking this test.)
Yes No

Training Site Locations*
Classes are scheduled to start the week of September 15, 2008.
Please indicate the site you would like to attend.

Central Westmoreland CTC — Youngwood
Northern Westmoreland CTC — New Kensington
Steel Center AVTS — Jefferson Hills
Apprentice is being registered by:*
Company Student
Is the individual a registered apprentice with the Department of Labor?
Yes No
Are you registered with NIMS and / or have you earned any NIMS Credentials?
Yes No

Please indicate below WHO will be
making payment for tuition and books*

 
Tuition: Company Student
Books: Company Student

NOTE: All tuition and book payments MUST be received prior to the start of classes. An invoice will be sent once tuition costs have been set.

The NTMA does not discriminate with reguard to race, creed, color,religion, sex, age , national origin,ancestry, or non-job related handicap or disibility.