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Nassau BOCES Adult Career and Technical Education Program Enrollment Application
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Student Name (Last Name, First Name)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
To which gender identity do you most identify?
*
Female
Male
Non-binary
Prefer not to say
Ethnicity
*
White or Caucasian, non-Hispanic
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Required
Home Address (Street/City/ZIP Code)
*
Your answer
Primary Phone Number
*
Your answer
Primary Email Address
*
Your answer
Emergency Contact - Name
*
Your answer
Emergency Contact - Relationship
*
Your answer
Emergency Contact - Phone Number
*
Your answer
Emergency Contact - Email Address
Your answer
Program of Interest (select all that apply)
*
Pet Grooming (Entrance Exam Required)
Veterinary Assistant (Entrance Exam Required)
Automotive Institute
Auto Collision
Light Diesel Engine
Environmental Technician (Entrance Exam Required)
Plumbing Technician
Trade Electric
Refrigeration and Air Conditioning Certified Technician
Welding
Cosmetology
Culinary Career Academy
Clinical Medical Assistant (Entrance Exam Required)
Dental Assistant (Entrance Exam Required)
Medical Billing/Coding (Entrance Exam Required)
Phlebotomy Technician (Entrance Exam Required)
Required
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