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College Bridge Program Registration
College Bridge Program Registration
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
Washington
County 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 Races
Ethnicity (optional)
Signature
I understand I am formally enrolling in courses offered by NCCC at my high school. I understand that NYS Education Law allows me to enroll in these courses without a signature from my parent or guardian. I am responsible for paying $60 for each course I select below unless I formally drop these courses before October 25, 2020.
Signature
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Last Updated 9/16/21
Last Updated