Atlantic Cape Community College - NJBIA Registration Form

Registration Form

Atlantic Cape Community College

Open Enrollment Classes

Fields marked with red asterisk (*) are mandatory.

COURSE SELECTION

Please select one or more courses you would like to attend. An email confirmation will be sent prior to the class.

Open Enrollment Courses

Mays Landing Campus

Team Building, Tuesday, March 12, 1:00-5:00pm

Cape May County Campus

YOUR PERSONAL INFORMATION

First Name*

Last Name*

Social Security Number-Last 4 digits*

Your Email*

Your Phone Number*

Date of Birth*

Date

Job Title*

Your Address*

Your City*

Your State*

Your ZIP*

Your Wage Code*

Ethnicity

Asian American/Asian/Pacific IslanderBlack/African American/AfricanHispanic/Latino/Chicano/SpanishNative American/American Indian/Alaska NativeWhite/Caucasian/European

EMPLOYER NAME & ADDRESS

Employer Name*

Federal Employer ID Number*

DUNS Number

Street Address*

City*

State*

Zip Code*

County*

Manager's E-Mail Address

Manager's Phone Number

ELECTRONIC SIGNATURE

Please read carefully and sign below.

The following statement is in accordance with the Higher Education Act. I grant permission to the College and NJ Community College Consortium for Workforce & Economic Development & Member Colleges to share information including the transfer of grades, credits, and other academic records, where applicable, among other organizations and/or agencies/businesses that provide funding for this training. I have secured my employer's approval for attending this course in accordance with the company policy and NJ Department of Labor (funding agency) regulations. College Cancellation Policy: If I am unable to attend the class I registered for, I must notify the College at least two business days prior to the class date.

PLEASE NOTE:

An employee may take each class once during the fiscal year (July 1 - June 30).

Your Initials*

Date: