Skilled Trades TRACK Pre-Apprenticeship Completion Certification

Today’s Date

First Name Middle

SSID

Program Area

Last

Address

City State Zip

Student Permanent E-mail (not school email)

School Name

School Address

Completing Instructor

Instructor Phone Instructor E-mail

List the required core courses that were successfully completed with final grade ** transcripts must be attached **

Course Grade

Course Grade

Course Grade

Course Grade

Are Safety Module Certificates on file from Labor Cabinet ETrain?

http://www.laborcabinetetrain.ky.gov/trackcourses.html

Name of End of Program Assessment

End of Program Assessment Grade ** transcripts must be attached **

By my signature below, I attest that the information contained within is accurate and that the above named student has successfully completed the SKILLED TRADES TRACK Pre-Apprenticeship program in accordance with the sponsoring organization's Registered Apprenticeship program and is eligible for the industry certification and accompanying completion certificate

_________________________________________________ ____________________ Student Signature Date

_________________________________________________ ____________________ Completing Instructor Signature Date

_________________________________________________ ____________________ Principal Signature Date

_________________________________________________ ____________________ TRACK Program Coordinator Signature Date

SUBMIT COMPLETED FORM BY MAIL: KDE/OCTEST - Mary Taylor, 300 Sower Blvd., 5th Floor, Frankfort, KY 40601 OR SCAN & EMAIL to Mary.Taylor@education.ky.gov

ALL COMPLETED CERTIFICATES WILL BE RETURNED TO THE SCHOOL AT THE ADDRESS ON RECORD