*First Name:

*Last Name:

*Address :

*City:

*State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenessee Texas Utah Vermont Virgina Washington Wisconsin West Virginia Wyoming

*Zip:

*Home Phone:

Work Phone:

*Email:

Permanent Address (if different from above)

Student:

If in school, name of school, city and state, and expected graduation date

Union Membership:

If union member, name of union and local. Indicate if your union will sponsor your participation to this training.

Current Position:

Please describe what you are doing now and how this relates to your interest in becoming a union organizer.

Organizing Experience:

For union members, please list any/all involvement you have had in your union. For non-union applicants, please share any relevant organizing experiences (student and community organizing).

Motivation:

Why do you want to be a union organizer?

References:

List names, address, and phone numbers of two individuals who know you, your work and your background.

Languages:

Indicate what languages you speak and write fluently.

Do you have a driver's License:
YES
NO

No driver's license:

When do you expect to have a driver's license?

Will you require vegetarian meals?
YES
NO

Feedback:

How did you hear about the APALA Organizing Institute

*Attach your resume:

Please attach your resume to complete this application.