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    Workforce Development Application

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    Personal Background
    Do you have a chosen/preferred first name that differs from your legal first name listed above?
    Do you have a chosen/preferred first name that differs from your legal first name listed above?
    Do you go by any other last name or do you have a maiden name that differs from your legal last name listed above?
    Do you go by any other last name or do you have a maiden name that differs from your legal last name listed above?
    Permanent Home Address
    Permanent Home Address
    Do you have a different mailing address?
    Do you have a different mailing address?
    Mailing Address
    Mailing Address
    Biographical Information
    Birthdate
    Birthdate
    Citizenship & Residency Information
    Privacy Protection Policy
    Privacy Protection Policy

    We are committed to protecting your privacy.

    Upon receiving the secure transmission of your Social Security Number, it is immediately encrypted. Only the last 4 digits of your Social Security Number are available in plaintext for identification and account matching purposes. Your Social Security Number is available for decryption only by those officials who oversee automated loading of personal information into student information systems, and only for that limited purpose.

    Our databases are actively monitored and are firewalled to ensure the protection of your personal information, and we employ all industry-standard safeguards.

    Race & Ethnicity
    Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.         View Definitions
    Definitions

    White: A person having origins in any of the original peoples of Europe, Middle East, or North Africa.

    Black or African American: A person having origins in any of the black racial groups of Africa.

    Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

    Asian: A person having origins in any of the original peoples of the Far East, Southest Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

    American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), who maintains cultural identification though tribal affiliation or community attachment.

    Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

    Are you Hispanic or Latino?
    Are you Hispanic or Latino?
    Please select one or more of the following that best applies to you:
    Please select one or more of the following that best applies to you:
    Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
    Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
    Program Information
    Academic Information
    Do you hold a high school diploma or GED?
    Do you hold a high school diploma or GED?
    Did you attend a high school outside the United States?
    Did you attend a high school outside the United States?
    Anticipated or Actual GED/TASC or HSE Diploma Date
    Anticipated or Actual GED/TASC or HSE Diploma Date
    High School/College Information
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    High School and College Information
    Please enter your academic information below, both high school and colleges attended outside of Rockland Community College.
    End Date
    End Date
    Expected Graduation Date
    Expected Graduation Date
    Add School
    No HS, GED/TASC or HSE Diploma Acknowledgement
    Delete_ID_
    No HS, GED/TASC or HSE Diploma Acknowledgement
    Additional Questions
    Have you ever been dismissed from a college for disciplinary reasons?
    Have you ever been dismissed from a college for disciplinary reasons?
    I understand that withholding information or giving false information may make me ineligible for admission to, or continuation at, the College. Therefore, by submitting this information, I certify that it is true, correct and complete. In addition, I understand that upon my enrollment I must abide by the policies and regulations of Rockland Community College.
    How did you hear about our Workforce programs?
    How did you hear about our Workforce programs?
    Accommodations
    If you are in need of disability-related accommodations, please call Ally Vincent at (845) 574-4345.
    Emergency Contact Information
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    Add Additional Contact
    Signature
    I agree to receive text messages (text message rates may apply)
    I agree to receive text messages (text message rates may apply)
    Upload Supporting Documents
    Please upload all required documents for your application.

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    145 College Rd, Suffern, NY 10901 – 845-574-4000
    Rockland Community College: A Part of the State University of New York System (SUNY)

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