MICRO-CREDENTIAL - REQUEST FOR REGISTRATION FORM

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* 1. Which course(s) are you registering for?

Course 1

Coures 2

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* 2. Contact Information

Legal first name

Middle name

Last name

Preferred name
(if applicable)

Former last name
(if applicable)

Street address

Apartment #

Mailing address
(if different from street address)

City

Province

Postal code

Email address

Home phone

Cell phone

Alternate phone

Your Social Insurance Number is needed to take part in the this course. Once registered as a student you will be required to provide it through our secure student service, CNC Connect.

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* 3. By entering your email address do you agree to receive emails from CNC Community & Continuing Education (which may include newsletters, promotional offers and announcements about courses and programs)?
Collected information will not be sold or shared with any third party.

Yes

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* 4. If we need to contact you during business hours how would you like to be reached?

Home phone

Cell phone

Alternate phone

Other (please specify)

Personal Information
This section of the application form must be completed in full. For audit purposes, the Ministry of Advanced Education requires the following information. Public Post-Secondary Institutions are bound by the Freedom of Information and Privacy Legislation. All information will be kept confidential.

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* 5. Date of birth
YYYY/MM/DD (Applicants must be 18 years of age or older)

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* 6. Do you identify as

Male

Female

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* 7. Do you identify yourself as an Aboriginal person?

Yes

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* 8. Employer

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* 9. Job Title

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* 10. Job Description
Two to three sentences

Request for Registration

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* 11. Hopeful Outcome
Please provide a brief description of how the course will increase your employability or increase your effectiveness in your current role.

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* 12. Self Report of Suitability
I acknowledge that in order to participate in the online micro-credential courses, I must have access to:

A Computer (See this sheet for more specific computer requirements)

Internet

Ability to communicate via video conferencing

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* 13. I understand that in order to set myself up for the greatest success, I must commit a minimum of 5 hours per week to course learning.
By typing your name below, you acknowledge the course requirements.

Name

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* 14. Applicant Prior Knowledge Assessment
By checking the box below, you are acknowledging that you have the indicated proficiencies.

Students are expected to have a basic proficiency in computer usage and the Microsoft Suite of programs.

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* 15. Are you being sponsored by your employer for this course?

Yes

I hereby authorize CNC to invoice my employer (noted below) for tuition and course fees as determined on the Sponsorship Application Form completed by my sponsoring agency. Please note, checking the 'yes' box and filling out your employer name constitutes your authorization of this information.

Post-Course Survey
In order to assess the outcomes of the micro-credential courses and work towards continued improvement and alignment with applicant needs, CNC Continuing Education will be conducting a post-course survey. Greater details of this survey will be provided upon course completion.

Please Note
Your application will be screened, prior to acceptance, and we will inform you of your status within 5 business days.

Collection of Information
The information on this form and all required admissions and registration documentation are collected for the purpose of meeting the data requirements for admission, registration, research, alumni and development, statistical analysis, locker and U-Pass administration, and the student health plan. It is collected under the authority of the College and Institute Act and your privacy is protected under the Freedom of Information and Privacy Act limiting how your information may be used or disclosed. If you have any questions about the collection and use of your information contact the Freedom of Information Coordinator, College of New Caledonia at 250 561 5828.

All hard copied materials/information provided by you in support of your application to CNC becomes the property of the College and will not be returned and may be destroyed within six months of receipt.

Declaration
I declare that the information that I have provided in this application is complete and correct. Completion of this signed application permits the College to request and/or confirm any information necessary to support my application for admission. Falsifying any document or information submitted will result in the cancellation of admission or registration at the College of New Caledonia.

I understand the submission of this application in no way guarantees admission to a program or course, and that admission is subject to meeting program or course prerequisites and space availability.

If I am admitted to the College of New Caledonia, I agree to familiarize myself with and to abide by the most current policies of the College during my tenure as a student.

In addition, I agree as a condition of registration at the College of New Caledonia to pay all fees and charges as approved by the Board of Governors to the College as required by the deadlines posted by the College, and to pay any interest charges on any sum which becomes due and payable according to the payment procedures at the College of New Caledonia.

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* 16. By clicking "agree" you are agreeing to the Collection of Information and Declaration noted above. By clicking "disagree", we will not be able to process your request and your request will be terminated.
If you would like to speak to an Office of the Registrar agent please email continuingedreg@cnc.bc.ca or call 250 561 5801.

Agree

Disagree

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* 1. Which course(s) are you registering for?

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* 2. Contact Information

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* 3. By entering your email address do you agree to receive emails from CNC Community & Continuing Education (which may include newsletters, promotional offers and announcements about courses and programs)?Collected information will not be sold or shared with any third party.

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* 4. If we need to contact you during business hours how would you like to be reached?

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* 5. Date of birthYYYY/MM/DD (Applicants must be 18 years of age or older)

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* 6. Do you identify as

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* 7. Do you identify yourself as an Aboriginal person?

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* 8. Employer

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* 9. Job Title

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* 10. Job DescriptionTwo to three sentences

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* 11. Hopeful OutcomePlease provide a brief description of how the course will increase your employability or increase your effectiveness in your current role.

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* 12. Self Report of SuitabilityI acknowledge that in order to participate in the online micro-credential courses, I must have access to:

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* 13. I understand that in order to set myself up for the greatest success, I must commit a minimum of 5 hours per week to course learning.By typing your name below, you acknowledge the course requirements.

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* 14. Applicant Prior Knowledge AssessmentBy checking the box below, you are acknowledging that you have the indicated proficiencies.

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* 15. Are you being sponsored by your employer for this course?

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* 3. By entering your email address do you agree to receive emails from CNC Community & Continuing Education (which may include newsletters, promotional offers and announcements about courses and programs)?
Collected information will not be sold or shared with any third party.

* 5. Date of birth
YYYY/MM/DD (Applicants must be 18 years of age or older)

* 10. Job Description
Two to three sentences

* 11. Hopeful Outcome
Please provide a brief description of how the course will increase your employability or increase your effectiveness in your current role.

* 12. Self Report of Suitability
I acknowledge that in order to participate in the online micro-credential courses, I must have access to:

* 13. I understand that in order to set myself up for the greatest success, I must commit a minimum of 5 hours per week to course learning.
By typing your name below, you acknowledge the course requirements.

* 14. Applicant Prior Knowledge Assessment
By checking the box below, you are acknowledging that you have the indicated proficiencies.