College Bridge Program Registration - Seaway 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

BIO 109 ELN---Human Biology---R. Michno-- MW---Full Year--- 8:30-11:00

BIO 109 ELN1---Human Biology Lab---R. Michno--- F---Full Year--- 8:30-11:00

BIO 109 ELN2---Human Biology---R. Michno--- MW---Full Year--- 11:30-2:00

BIO 109 ELN3---Human Biology Lab---R. Michno--- F---Full Year---11:30-2:00

CRJ 101 ELN---Criminal Justice---J. Colon---MTWRF---Fall 11:30-12:45

CRJ 102 ELN---Police in Contemp Society---J. Colon---MTWRF---Fall---12:45-2:00

CRJ 135 ELN---Intro to Corrections---J. Colon--- MTWRF---Spring 11:30-2:00

CRJ 208 ELN---Criminal Investigations---J. Colon---MTWRF---Fall---8:30-1100

HEA 101 ELN---Medical Terminology---J. Carkner/A. Farrand---T---Full Year 8:30-11;00

HEA 101 ELN1---Medical Terminology---R. Michno--T---Full Year 11:30-2:00

HEA 101 ELN2---Medical Terminology---R. Michno---T---Full Year 8:30-11:00

HEA 101 ELN3---Medical Terminology---J. Carkner/A. Farrand---T---Full Year 11:30-2:20

HED 101 ELN---Conc Well/Phy Fitness---J. Carkner/A. Farrand---MW---Full Year---11:30-2:00

HED 110 ELN---Emergency Care & Safety---J. Colon--- MTWRF---Spring---8:30-11:00

HED 110 ELN1---Emergency Care & Safety---J. Carkner/A. Farrand---MWF---Spring 11:30-2:00

HED 115 ELN---NVPM---Cardio Pulmonary Resuscitation---J. Colon---R---Spring---11:30-1:30

HED 140 ELN---NVPM---Basic First Aid---R. Michno---R---Spring---1:30-2:00

HED 115 ELN1---NVAM---Cardio Pulmonary Resuscitation---J. Colon---R---Spring---8:30-10:30

HED 140 ELN1---NVAM---Basic First Aid---R. Michno---R---Spring--10:30-11:00

HED 115 ELN2---CJ---Cardio Pulmonary Resuscitation---J. Colon---R---Fall---8:30-10:30

HED 140 ELN2---CJ---Basic First Aid---J. Colon---R---Fall--10:30-11:00

HED 115 ELN3---HCPM---Cardio Pulmonary Resuscitation---J. Colon---R---Fall---11:30-1:30

HED 140 ELN3---HCPM---Basic First Aid---J. Carkner/A. Farrand---R---Fall---1:30-2:00

HUS 161 ELN---Intro to Child and Family Services---K. Merchant---MWF---Full Year---11:30-2:00

ENG 101 ELN---English Composition I---J. Barstow/K.Merchant---RF---Full Year---11:30-2:00

EDU 201 ELN---Foundations of Education---K. Merchant---MWF---Full Year---8:30-11:00

ENG 105 ELN---Speech Fundamentals---J. Barstow/K. Merchant---RF---Full Year---8:30-11:00

ART 105 ELN---Introduction to Computer Graphics - J. McCarthy - MTWRF - Full Year - 9:00-11:20

ART 105 ELN1---Introduction to Computer Graphics - J. McCarthy - MTWRF - Full Year - 12:00-2:20

MAT 120 ELN---Intro to Math Concepts---Staff---M-F---Full Year---8:30-11:00

ENG 105 ELN1---Speech Fundamentals---J. Barstow/Ostraki---RF---Full---8:30-11:00

HED 115 ELN4---EHS---Cardio Pulmonary Resuscitation---S. Robinson---R---Spring---8:30-11:00

HED 140 ELN4---EHS---Basic First Aid---S. Robinson---R---Spring---8:30-11:00

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 $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

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