Registered Apprenticeship Sponsor – Articulation Agreement Review

U.S. Department of Labor
Employment and Training Administration
Office of Apprenticeship
OMB Approval No. 1205-0512
Expiration Date: 8/31/2016

Registered Apprenticeship-College Consortium (RACC)
Application for Registered Apprenticeship Sponsor Membership
Registered Apprenticeship Sponsor Members of the RACC may be one of the following. Please check
the appropriate category.
National sponsors including all training centers or
National sponsors with multiple training centers but not all centers
Regional sponsors including all training centers or
Regional sponsors with multiple training centers but not all centers
(If you are applying for membership for more than one site, please provide the contact information for the site as
well as the information for the community college with which it has an articulation agreement.
Sponsor with a single site.
Point of Contact: Name_________________________________________
Title___________________________________________________________
Name of Sponsor
___________________________________________________________________________________
Address (street)___________________________________________________________________________
City_________________

State ________

Website Address ____________________

Zip code __________________
Phone ______________________

For national sponsors,
Do you have a national articulation agreement with a two-year post-secondary institution?

Yes

No

With four-year post-secondary institution?

Yes

No

Please list each of your training centers and each two- or four-year post-secondary institution with which you
have articulation agreements. (Please fill out a copy of Attachment A for each of the local training centers
or two- or four-year post-secondary institution that the national applicant has an articulation agreement
with.)
Point of Contact at Local Training Center
__________________________________________________________________
Name of Training Center
______________________________________________________________________________
Address of Training Center__________________________________________________________________
Street, City, State, Zip______________________________________________________________________
Phone Number ___________________________________

Website Address (if different from national website)________________________________________________

Point of Contact at two- or four-year post-secondary institution
__________________________________________________________________
Name of
Institution_________________________________________________________________________________
Address of
Institution_________________________________________________________________________________
Phone_________________________
Website Address
___________________________________________________________________________________
How many credits do you articulate to college credit for completing a Registered Apprenticeship certificate?
____________
Do you articulate any credentials or industry certificates towards college credit?

Yes

No

If yes, what credentials or certificates and how much credit:

Name of entity which conducted a third party assessment of your Registered Apprenticeship program to
determine the quality, rigor and determination of credit value (American Council on Education, college,
etc.)
Name of Third Party Validator
______________________________________________________________________
Name_________________________________________________________________
Address (Street)
__________________________________________________________________________________
City _____________

State________________

Zip___________________

Phone____________________________________________
How many credits do they recommend the Registered Apprenticeship program is worth?
________________

POINTS-OF-CONTACT
RACC Institutional Representative
This policy-level administrator is responsible for implementing and overseeing institution’s compliance with the
RACC Principles and Criteria:
Name____________________________________________________________________________________

Address (Street)
__________________________________________________________________________________
City _____________

State________________

Zip___________________

Phone____________________________________________
E-mail____________________________________________________________________________________

(The RACC framework will be on the Pathways to Success homepage.)
AFFIRMATION OF COMPLIANCE WITH RACC PRINCIPLES AND CRITERIA
This application has been reviewed and authorized by the sponsor’s president or CEO. The sponsor agrees that
its designated subdivisions will comply with the RACC Principles and Criteria.

Electronic Signature of President, CEO, or other senior administrator authorized by President or CEO to make
this commitment
Date_____________________

Name___________________________________________________________________________________
Position __________________________________________________________________________________
Phone __________________________________________________________________________________
E-mail ___________________________________________________________________________________

Public reporting burden for this collection of information, which is voluntary, is estimated to average 10 minutes per application, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship, Room
C-5317, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0512).