Associations and Other Organizations – RACC Application

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

Registered Apprenticeship-College Consortium (RACC)
Application for “Other” Category Membership
This application is for national, regional, or state associations or other organizations that
represent two- and four-year post-secondary institutions and Registered Apprenticeship
sponsors. Organizations serve in a coordinating role to facilitate membership in the
consortium.
Please check the appropriate category.
_____ National Representative of Two- and/or Four-Year Post-Secondary Institutions
_____ State Representative of Two- and/or Four-Year Post-Secondary Institutions
_____ Regional Representative of Two- and/or Four-Year Post-Secondary Institutions
_____ Other
_____ National Representative of Registered Apprenticeship Sponsors
_____ State Representative of Registered Apprenticeship Sponsors
_____ Regional Representative of Registered Apprenticeship Sponsors
_____ Other
Point of Contact: Name_________________________________________
Title___________________________________________________________
Name of Organization_________________________________________________________________________________
Address (street)___________________________________________________________________________
City_________________

State ________

Website Address ____________________

Zip code __________________

Phone ______________________ Cell _________________________

Please describe your relationship with the apprenticeship program or the colleges (national association, membership
organization, other).

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____________________________________________ Cell ___________________________________________

E-mail___________________________________________________________________________________________
Phone____________________________________________ Cell ___________________________________________
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 organization’s president or CEO. The sponsor agrees that its
designated subdivisions will comply with the 2011-2013 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 N-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0512).