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*

Please add me to the customized training contact list to be notified when new courses are availableFor 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*

Ethnicity

Asian American/Asian/Pacific IslanderBlack/African American/AfricanHispanic/Latino/Chicano/SpanishNative American/American Indian/Alaska NativeWhite/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: