Brooklyn College Registration Form Fall 2020

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Last name *

First name *

Personal email address *

Mobile phone # *

I am interested in taking all four courses for SWD certification *

YES

I am interested in taking some but not all of the courses for grad credit only. *

YES

𝐈𝐟 𝐲𝐨𝐮 𝐚𝐫𝐞 𝐫𝐞𝐠𝐢𝐬𝐭𝐞𝐫𝐢𝐧𝐠 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐟𝐢𝐫𝐬𝐭 𝐜𝐨𝐮𝐫𝐬𝐞, 𝐩𝐥𝐞𝐚𝐬𝐞 𝐬𝐞𝐧𝐝 𝐚 $𝟕𝟓𝟎 𝐜𝐡𝐞𝐜𝐤 𝐨𝐫 𝐌𝐎, 𝐩𝐚𝐲𝐚𝐛𝐥𝐞 𝐭𝐨 𝐋𝐈𝐍𝐃𝐄𝐍𝐇𝐔𝐑𝐒𝐓 𝐏𝐒/𝐎𝐖𝐋, 𝐭𝐨 𝐭𝐡𝐞 𝐎𝐖𝐋 𝐓𝐞𝐚𝐜𝐡𝐞𝐫 𝐂𝐞𝐧𝐭𝐞𝐫, 𝟑𝟓𝟎 𝐃𝐚𝐧𝐢𝐞𝐥 𝐒𝐭., 𝐋𝐢𝐧𝐝𝐞𝐧𝐡𝐮𝐫𝐬𝐭, 𝐍𝐘 𝟏𝟏𝟕𝟓𝟕. 𝐏𝐚𝐲𝐦𝐞𝐧𝐭 𝐢𝐬 𝐝𝐮𝐞 𝐛𝐲 𝐎𝐜𝐭𝐨𝐛𝐞𝐫 𝟔, 𝟐𝟎𝟐𝟎. 𝐎𝐧𝐜𝐞 𝐲𝐨𝐮 𝐚𝐫𝐞 𝐫𝐞𝐠𝐢𝐬𝐭𝐞𝐫𝐞𝐝, 𝐲𝐨𝐮 𝐰𝐢𝐥𝐥 𝐡𝐞𝐚𝐫 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐢𝐧𝐬𝐭𝐫𝐮𝐜𝐭𝐨𝐫 𝐬𝐡𝐨𝐫𝐭𝐥𝐲 𝐛𝐞𝐟𝐨𝐫𝐞 𝐭𝐡𝐞 𝐜𝐨𝐮𝐫𝐬𝐞 𝐛𝐞𝐠𝐢𝐧𝐬. 𝐈𝐟 𝐲𝐨𝐮 𝐩𝐥𝐚𝐧 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐚𝐥𝐥 𝐟𝐨𝐮𝐫 𝐜𝐨𝐮𝐫𝐬𝐞𝐬, 𝐲𝐨𝐮 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐧𝐨𝐭𝐢𝐟𝐢𝐞𝐝 𝐨𝐟 𝐩𝐚𝐲𝐦𝐞𝐧𝐭 𝐢𝐧𝐬𝐭𝐫𝐮𝐜𝐭𝐢𝐨𝐧𝐬 𝐚 𝐦𝐨𝐧𝐭𝐡 𝐛𝐞𝐟𝐨𝐫𝐞 𝐞𝐚𝐜𝐡 𝐜𝐨𝐮𝐫𝐬𝐞 𝐛𝐞𝐠𝐢𝐧𝐬. 𝐏𝐥𝐞𝐚𝐬𝐞 𝐧𝐨𝐭𝐞 𝐭𝐡𝐚𝐭 𝐰𝐞 𝐦𝐮𝐬𝐭 𝐡𝐚𝐯𝐞 𝐚 𝐦𝐢𝐧𝐢𝐦𝐮𝐦 𝐨𝐟 𝟏𝟖 𝐩𝐞𝐨𝐩𝐥𝐞 𝐫𝐞𝐠𝐢𝐬𝐭𝐞𝐫𝐞𝐝 𝐭𝐨 𝐫𝐮𝐧 𝐞𝐚𝐜𝐡 𝐜𝐨𝐮𝐫𝐬𝐞.

I would like to register for the first course, and will send my payment of $750 before October 6, 2020. *

YES

THE MOST CONVENIENT STARTING TIME FOR YOU: *

4:00 PM

4:15 PM

4:30 PM

4:45 pm

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Lindenhurst Public Schools. Report Abuse

Forms