Your College Name Here

Camden County College

Fields marked with red asterisk (*) are mandatory.

COURSE SELECTION

Please select an ONLINE course you would like to attend. Please note, a registration form is required for each class you would like to attend. If you are interested in participating in a class that is no longer visible on this form, please e-mail: customizedtraining@camdencc.edu to determine if there is a waiting list or if the class is cancelled. An automatic registration confirmation will be displayed on your computer screen once you register for a class. An email will also be sent 1 to 2 days before class, which will provide final class details, including a Zoom link. For course descriptions, click here . *Please note all classes are online and will be taught in a condensed format*

Courses *

Problem Solving- Dealing with Difficult People, 2/2/22, 9:00am to 1:00pm, ONLINE*Problem Solving - Dealing with Difficult People, 2/2/22*2/2/22*4*Camden County College*Open PowerPoint I 2016, 2/8/22, 9:00am to 1:00pm, ONLINE*PowerPoint I 2016, 2/8/22*2/8/22*4*Camden County College*Open The Professional Supervisor (for experienced managers), 2/9/22, 9:00am to 1:00pm, ONLINE*The Professional Supervisor (for experienced managers), 2/9/22*2/9/22*4*Camden County College*Open For Camden County College Use ONLY

YOUR PERSONAL INFORMATION

First Name *

Last Name *

Your Email *

Your Phone Number *

Date of Birth

Date

Job Title *

Your Address

Your City

Your State

Your ZIP

Your Wage Code *

A=$10/hour or less B=$11-$15/hour C=$16-$20/hour D=$21-$24/hour E=$25/hour or above

Ethnicity

Asian American/Asian/Pacific Islander Black/African American/African Hispanic/Latino/Chicano/Spanish Native American/American Indian/Alaska Native White/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 seven business days prior to the class date. I understand that if I do not cancel within this time period, my employer or I may incur a $100 cancellation fee. I understand that I have the option to send an eligible participant to attend the class in my place. I will contact the College with the replacement"s contact information within 48 hours before the class date.

Your Initials *

Date: