Workshop & Training Student Registration

Thank you for your interest in registering for courses with Jefferson Community College!

COURSE LISTINGS
To view our course offerings please visit the Course Listings page on our website.

HOW TO REGISTER
Complete the below application in its entirety. If applicable, please provide a copy of your High School diploma or equivalent. If you have questions about registration and payment, please call 315-786-2233 to schedule an appointment.

Registration with payment secures a seat in the classroom. To receive a full refund, registrant must call 315-786-2233 within 24 business hours (Mon. – Fri.) of the start date. No refund after start date. Workforce Development and Business Division reserves the right to make changes to workshop date/time and cost(s). If cancelled by the college, registrant will receive a 100% refund. For inclement weather updates call: 315-786-6565. The general rule for inclement weather is if campus is closed, the workshop is cancelled.

Are you registering for a youth program?

Student Information

Parent Information

First Name

Last Name

Other/Previous Name (which may appear on records)

Birthdate

Social Security Number - Optional (Please enter your full SSN, this is required to log in to MyJCC)

Home Phone

Cell Phone

Mailing Address

Country

Street

City

Region

Postal Code

Student Information

First Name

Last Name

Student Date of Birth

Census Information

Sex Assigned at Birth:

Gender Identity (Optional):

Additional Gender Information (Optional):

Country of Citizenship:

Permanent Resident?

Residency Card Number:

Visa Type:

Race/Ethnicity:

Are you of Hispanic or Latino origin?

Select Your Background:

Military Affiliation:

If you are a military spouse, will you be submitting an application for funding through MyCAA? (Note – Eligibility for MyCAA varies, learn more.)

Military Affiliation

School District

If you would like to self-identify with a disability please mark the appropriate category(ies). Someone from the Accommodative Services Office will reach out to connect with you about available services.

Specify "Other":

Are you unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment?

You have worked primarily without pay to care for a home and family and for that reason you have diminished marketable skills and you have been dependent on the income of another family member but are no longer supported by such income.

You are a parent whose youngest dependent child will become eligible to receive assistance under Part A of Title V of the Social Security Act not later than two years after the date on which the parents applies for assistance under this Title.

School Information

Admissions into this course does not require the applicant to have a high school diploma or GED. However, many of the national exams do require the examinee to have a high school diploma or GED in order to sit for the certification.

Education Data

Student Registration

Search our Course Listings to find the Course Code.

Course 1

Workshop Title (hold ctrl and click to select more than one)

Please complete the following Certification form on DocuSign (opens in new tab/window): Clinical Medical Assistant Certification Form

Please complete the following Certification form on DocuSign (opens in new tab/window): Pharmacy Technician Certification Form

Please complete the following Certification form on DocuSign (opens in new tab/window): Phlebotomy Technician Certification Form

Please complete the following Certification form on DocuSign (opens in new tab/window): Medical Billing and Coding Certification Form

Certification form completion:

I have completed the required Certification of Information & Commitment form using the link provided.

Third Party Payment

Name

Address

Phone Number

Jefferson Community College Website

Workshop & Training Student Registration