Microcredential Application Form

First Name

Middle Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Cell Phone Number

Supplying your cell phone number will opt you into receiving text messages related to your FLCC application and enrollment/registration process. Message rates may apply.

Date of Birth

Email Address

Ethnicity/Race (optional): Are you Hispanic/Latino?

Yes

No

Please indicate your race (select one or more):

Have you ever been expelled and/or dismissed from a college for disciplinary reasons?

Yes

No

Are you currently enrolled in an FLCC degree or certificate program?

Yes

No

Which microcredential program are you interested in?

Academic Year

Semester you are registering for:

Spring

Summer

Fall

Winter

I acknowledge that I can read and understand the statements and policies as set in the FLCC catalog, including but not limited to the FLCC’s Student Code of Conduct, which outlines student rights, responsibilities, prohibited behaviors, and possible sanctions for all students enrolled in any coursework.

I certify that I have met all stated prerequisites for the course(s) listed above.

I acknowledge that my tuition and fees will be paid by the tuition due date and that I am liable for any collection fees, attorney costs and fees. I have reviewed and understand the college's refund policies and if I decide not to attend FLCC, I will submit an Official Withdrawal form prior to published deadlines, and I realize that non-attendance in class will not relieve my financial responsibility.

I understand that FLCC may use an automated calling system and pre-recorded message to contact me by phone regarding my affiliation with the college.

I attest that I am the individual identified in this form, and agree to use my typed signature as my legal signature on this form.

Signature (I acknowledge and agree to the above statements)

Nondiscrimination Notice: Finger Lakes Community College does not discriminate based on an individual's race, color, national origin, religion, creed, age, disability, sex, gender identity, gender expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence status, or criminal conviction.