Experiential Learning Interest Form

Contact Information

First Name

Last Name

Date of Birth

* must be 16 years or older to participate in the program

Are you Dallas College Student?

YesNo

Student ID

Email Address

Preferred Communication Method

CallTextEmail

Preferred Phone

MobileHomeI do not have a phone

Home Phone

Mobile Phone

Because you are under the age of 18, we also need your parent information.

Parent Name

Parent Email Address

Are you currently a Dual Credit Student?

YesNo

Major

If you are not a Dual Credit student, please select a Major.

What areas of Financial Aid are you eligible for?

Pell GrantWork StudyUnknown

Select your program interest.

Pre-Apprenticeship - Apprenticeship – Long-term experience (up to 1 year)Internship - Short-term experience (3-6 months)Co-ops – Work experience related to a field of study.Practicum - Work experience in a discipline applied to a course.Clinicals - Work experience applied to theory related to healthcare.Information TechnologyAdvance ManufacturingTransportationLogisticsOther

Where did you hear about the Internships or Apprenticeship Opportunity?

Are you interested in a company tour?

YesNo

Are you interested in attending a program event(s)?

YesNo

Which campus are you located or interested in attending?

TechFields

t_Age

t_Under18