State of Nevada
Eligible Training Provider List
Workforce Innovation and Opportunity Act

Initial Registration Form for Apprenticeship Program

This form will allow you to register as a Program that provides one or more apprenticeships. It also allows you to register your first apprenticeship and its corresponding 5910 form. If you want to register additional apprenticeships with their unique 5910 forms, you can do so after this initial registration goes through and it has been verified that all required information was submitted. You will receive an email notification when this happens. At that time you can use the "add an apprenticeship" form to register additional apprenticeships.
1. Provide the name, address, and phone number of the Registered Apprenticeship Program Sponsor.
A. Name of Apprenticeship Program
B. Address Line 1
C. Address Line 2
D. City, State, Zip , ,
E. Phone Number
2. List all occupations included with your Registered Apprenticeship Program.

+ Add Row
3. Provide the name of the unique apprenticeship you want to register and attach the corresponding State Apprenticeship Council approval letter (form 5910) you received from the state, signed by the Secretary Director of Apprenticeship. Make sure to attach it in PDF format.
A. Name of Apprenticeship
B. Form 5910
4. Provide the name, address and phone number of the Related Technical Instruction provider and the location of instruction, if different from the program sponsor's address.
A. Name of the Related Technical Instruction Provider
B. Address Line 1
C. Address Line 2
D. City, State, Zip , ,
E. Phone Number
F. Is location of instruction the same as the program sponsor's address?
5. Provide the method and length of instruction.
A. Method of instruction
(400 characters maximum)
B. Length of Instruction Hours per week: Number of weeks:
6. Provide the number of active apprentices in this unique apprenticeship.
Name of authorized representative
Title of authorized representative
Phone number of authorized representative
By typing my name in the following box I certify the above statements to be verifiable, true and correct, to the best of my
knowledge, and that this information can be used for the purpose of processing this registration form.
Signature of authorized representative
Date   mm/dd/yy
Email Address
When all requirements have been verified, your program will be added to the State's Eligible Training Provider List. Please indicate which Local Workforce Development Board you are submitting your registration form to.
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