WFD/ MC Template

Thank you for your interest in one of our Workforce Development Program. Please complete this form in it is entirety. These fields are required for New York State.
Complete the below form to begin the process of registering for this microcredential. Any questions, please do not hesitate to reach out to pernatdg@cobleskill.edu.

*Required

Student Information

First Name

Middle Name

Last Name

Chosen First Name

Personal Pronouns (Optional)

He, Him, His

She, Her, Hers

They, Them, Theirs

Birthdate (Select Month/Day/Year)

Legal Sex

Male

Female

X

Gender Designation

Male

Female

Non-Binary

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone Number

Mobile Phone Number

Email Address

Social Security Number

Global ID (if you know it and it has been assigned to you)

Driver's License or other ID (copy)

Academic Information

Are you a current student or were you ever a SUNY Cobleskill student?

Yes

No

What campus is providing the training?

SUNY Cobleskill Ag & Tech

What department?

IRV

Program Name

Are you interested in a microcredential?

Registration Information

All applicants must complete the following section.

Microcredential students may enroll in SUNY Cobleskill courses as long as the student meets course pre-requisites. Students must also provide a copy of their ID.
• Microcredential students may only enroll in up to 11 credit hours per semester.
• Microcredential students are NOT eligible for financial aid.
• Microcredential students may NOT accumulate more than 12 credit hours

Are you a US Citizen?

Yes

No

Are you a New York State Resident?

Yes

No

NYS residency

Yes

No

County of Residence

Please identify the following about your high school history or equivalency:

I have graduate from high school

I will graduate from high school

I have a GED

I have withdrawn from high school

(Race/ Ethnicity) Federal civil rights legislation and implementing regulations require the College to submit counts on the students body of racial/ ethnic categories. Your cooperation is essential to the accurate reporting of this information.

Have you been dismissed and/or suspended from a college for disciplinary?

Yes

No

Employment Information

Current Industry Sector Use this LIST

Current Employer

Acknowledgment

I understand that this application cannot be processed if it has not been completed according to instructions and that all information submitted is true to the best of my knowledge. Any deliberate falsification or omission of data may result in denial of admission or in dismissal.

I acknowledge the above statement

Yes

Please type your full name in place of your signature.

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WFD/ MC Template