College Bridge Program Registration - Boquet Valley

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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

HIS 151 EBV---American History I---Staff--Basile---M-F---Fall---1:24-2:03

HIS 152 EBV---American History II---Staff---Basile---M-F---Spring---1:24-2:03

POS 102 EBV---Government and Politics---Basile---Fall---M-F---9:12-9:51

ECO 101 EBV---Microeconomics--Basile---Spring---M-F---9:12-9:51

FRE 101 EBV --- (French 3) Intro to French ---MTWRF---Full year 10:36-11:15

FRE 102 EBV --- (French 4) Intro French II --- MTWRF---Full year---8:30-9:09

FRE 201 EBV --- (French 5) Intermediate French---MTWRF--- Full year 9:54-10:33

HUM 126 EBV---World Cultures---J. Chan-Seng---MWF--- Full year---7:45-8:27

ENG 101 EBV---English Composition---K. Moore---MTWRF---Full Year---9:12-9:51

ENG 105 EBV---Principles of Speech---Sarah Rice---MWF---Full Year---10:36-11:15

ENG 112 EBV---Literature--- Kelsey Moore ---MTWRF---Full Year---1:24-2:03PM

MAT 121 EBV - Elementary Statistics - John Fairchild - MTWRF- Full Year---9:54-10:33

MAT 132 EBV - Pre-Calculus - John Fairchild - MTWRF - Full Year---11:18-11:57

MAT 240 EBV - Calculus - Fairchild - MTWRF - Full Year ---8:30-9:09

BUS 212 EBV---Marketing---Jason Colby ---MTWRF---Full Year---9:12-9:51

BUS 215 EBV---Small Business Management---Jason Colby ---MWF---Full Year---7:45-8:27

BIO 104 EBV---Environmental Science---Kaitlin Fielder---MTWRF---Full Year---12:42-1:21

SPA 101 EBV---Intro to Spanish---Steve Hudson---MTWRF---Full---2:30-3:15

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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