Behavioral Health Apprenticeship 2024-2025 Application Form

This is a pilot program and offers up to 3000.00 per applicant. This application will be closed as of April 1, 2025

Please note that in order to be considered applicant must be a Washington State resident

Apprentice Information:

Your apprentice program location and the name of the coordinator and contact information for the coordinator is needed to verify your

Program Cohort:

Program Coordinator Name and Contact Information:

Program

Race/Ethnicity

Do you have a disability

Gender

Other:

What is your primary language?

Please list amount requested

Please list what funds would be used for (examples: child care, materials, technology, housing, transportation, and food.)

Applicant Information

Legal First Name:

Legal Middle Initial:

Legal Last Name:

Preferred First Name:

Preferred Last Name:

Mobile Phone Number:

Email Address:

SSN or ITIN:

Date of Birth:

City:

Street:

Zip Code:

State:

Preferred Method of Contact

CellTextEmail

Are you a Washington Resident?
(Living in WA for 1 or more years primarily for purposes other than postseconday education)

YesNo

NOTE*

Apprentices must be WA state residents to be eligible to receive funding.