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Registration S3P101 NJBIA PowerPoint Introduction 365 - Open Enrollment-SBDC - 03/16/2023

Please complete this form.

* REQUIRED

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* 1. Student Name

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* 2. Date of Birth MM/DD/YYYY

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* 3. Job Title

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* 4. Contact Information (REQUIRED)

Company Name *

Address *

City *

State *

ZIP *

County

Company Email *

Company FEIN# *

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* 5. Hourly Wage Code

A) $10. per hour or $20,800. or less per annum

B) $11. - $15. per hour or $22,880. - $31,200. per annum

C) $16. - $20. per hour or $33,280. - $41,600. per annum

D) $21. - $25. per hour or $43,680. - $52,000. per annum

E) $26. or higher per hour or $54,080 or higher per annum

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* 6. Enter your initials and today's date in the box below to grant permission to the 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.

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* 7. CANCELLATION POLICY:
If I am unable to attend the class I registered for, I must notify the College prior to the class date. 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.

Enter your initials below to acknowledge this cancellation policy.