College Bridge Program Registration - NorthWest Tech

If you see this don't fill out this input box.

Student First Name*Student First Name

Student Last Name*Student Last Name

Student Middle Initial*Student Middle Initial

SSN*SSN

Home Address*Home Address

Home City*Home City

Home State*Home State

Home Zip Code*Home Zip Code

County of Residence* Please Select Essex Franklin Hamilton St. Lawrence Lewis Clinton Warren WashingtonCounty of Residence

Date of Birth*Date of Birth

High School Level

Junior

Senior

High School Level

Home High School*Home High School

College Bridge Program Location*College Bridge Program Location

Family Telephone Number*Family Telephone Number

Student Email Address*Student Email Address

Gender

Female

Male

Other/Non-Binary

Gender

Citizenship

I am a US Citizen

I am not a US Citizen

I am an international student

Citizenship

Ethnicity (optional) Please Select American Indian/Alaskan Native Native Hawaiian/Pacific Islander Asian White Black/African American Hispanic Two or More RacesEthnicity (optional)

Location Courses

ART 105 ELO---Intro to Computer Graphics---Ladouceur---MTWRF---Full Year---12:00-2:20

BIO 109 ELO---Human Biology---Christman---MW---Full---9:00-11:20

BIO 109 ELO1---BioLab---Christman---F---Full------9:00-11:20

BIO 109 ELO2---Human Biology---Christman---MW---Full---12:00-2:20

BIO 109 ELO3---BioLab---Christman---F---Full------12:00-2:20

CRJ 101 ELO---Criminal Justice---Disalvo---MTWRF---Fall---12:00-2:20

CRJ 102 ELO---Police in Contemp Society---Disalvo---MTWRF---Fall---12:00-2:20

CRJ 135 ELO---Intro to Corrections---Disalvo---MTWRF---Spring---12:00-2:20

CRJ 208 ELO---Criminal Investigations---Disalvo---MTWRF---Fall---9:00-11:20

HEA 101 ELO---Medical Terminology---Farrand---MW---Full Year---12:00-2:20

HEA 101 ELO1---Medical Terminology---Christman---TR---Full Year---9:00-11:20

HEA 101 ELO2---Medical Terminology---Christman---TR---Full Year---12:00-2:20

HED 101 ELO---Conc Well/Phy Fitness---Farrand---MW---Fall---9:00-11:20

HED 110 ELO1---Emergency Care & Safety---Farrand---MWF---Spring---12:00-2:20

MAT 120 ELO---Intro Math Concepts---Farrand---TR---Spring---9:00-11:20

HUS 161 ELO---Intro to Children and Family Services---Duprey---MTWRF---Full---9:00-11:20

HUS 161 ELO1---Intro to Children and Family Services---Duprey---MTWRF---Full---12:00-2:20

ENG 101 ELO---Eng Comp---Barstow/Duprey-Full year 9:00-11:20

ENG 101 ELO1---Eng Comp---Barstow/Duprey--Full year 12:00-2:20

ENG 105 ELO---Principles of Speech---Barstow/Duprey---Full year 9:00-11:20

ENG 105 ELO1---Principles of Speech---Barstow/Duprey---Full year 12:00-2:20

ENG 105 ELO2---Principles of Speech---Barstow/Duprey---Full year 8:30-11:00

HED 110 ELO---Emergency Care & Safety---Disalvo---MTWRF---Spring---9:00-11:20

HED 115 ELO---(CJ-AM)Cardio Pulmonary Resuscitation---Robinsom/DiSalvo---R---Fall---9:00-10:00

HED 140 ELO- (CJ- AM)---Basic First Aid---Robinson/DiSalvo- R- Fall- 10:00-11:20am

HED 115 ELO1---(HC - PM)Cardio Pulmonary Resuscitation---Robinson/Farrand---R---Fall---12:00-1:00

HED 140 ELO1- (HC-PM)---Basic First Aid---Robinson/Farrand- R- Fall-1:00-2:20

HED 115 ELO3---(NV-AM)Cardio Pulmonary Resuscitation---Robinson/Christman---R---Fall---9:00-10:00

HED 140 ELO3-NV-AM---Basic First Aid---Robinson/Christman- R- Fall- 10:00-11:20am

HED 140 ELO4 --(NVM-PM) --Basic First Aid --Robinson/Christman - Fall --1:00-2:20

HED 115 ELO4 (NVM - PM) – CPR – Robinson/Christman - Fall-- 12:00-1:00

HED 140 ELO5 (NVE-PM)---Basic First Aid--- Robinson/Duprey---FY---M-F--- 1:00-2:20

HED 115 ELO5 (NVE-PM)---CPR--- Robinson/Duprey ---FY---M-F--- 12:00-1:00

HED 140ELO6 (NVE-AM)---Basic First Aid--- FY----M-F---Robinson/Duprey 9:00-10:00

Please check the boxes of the classes you will be taking for college credit this year:

Signature

I understand that by signing this registration form I am formally enrolling in courses offered by North Country Community College at my high school. I have indicated my choice on the form below. I understand that New York State Education Law allows me to enroll in these courses without a signature from my parent or guardian.

I am responsible for paying up to $75 for each course I select below. I understand that I will receive a green bill at my mailing address which I will have to pay unless I formally drop these courses before October 18 2024. I can inform my instructor and/or guidance counselor prior to that date. If I do not I will still have to pay for the course even if I choose not to participate at a date after October 18, 2024.

I further understand that I will need to provide my social security number to facilitate official enrollment receipt of transcripts and reporting processes as established under Section 355 of the Education law of the State of New York. If I do not provide my social security number by October 18 2024, I will be removed from the program without notice.

Signature

Submit   Clear