Rescue Ops 1

FEE WAIVER INFORMATION

Department/Station Name:
If you are not eligible for a fee waiver, please enter N/A.

Job Title:
If you are not eligible for a fee waiver, please enter N/A.

Please select what agencies you are currently affiliated with. If you work AND/OR volunteer in any of the below capacities, please SELECT ALL that apply to you.
If you are not eligible for a fee waiver, please select 'Not applicable.'

Privacy Policy
I understand that CCCC abides by FERPA regulations and will not release my information unless I expressively give CCCC permission to do so. I understand that if I choose one of the following: affiliate my course enrollment(s) with a company or group, OR request that my company or group be billed directly for my courses, CCCC will release to the appropriate company or group my enrollment information (account number, course, schedule, delivery method, location, tuition and fees).

My electronic signature below indicates that the information on this form is accurate and attests that I meet the eligibility criteria as indicated on this form to qualify for a fee waiver.

Click to Sign...

FIRE/RESCUE: By my signature above, I authorize Central Carolina Community College to release to NC Fire & Rescue Commission a report indicating I have successfully completed all requirements for certification. Please note: your full Social Security Number is required for grade transfer.

Media Release Authorization:
I am 18 years of age or older and give permission to the employees, representatives, and agents of Central Carolina Community College and the North Carolina Community College System to record, produce, distribute, and transmit reproductions, recordings, and interviews of myself through printed, visual, and electronic means. I authorize such use in teaching materials, media releases, and advertisements for purposes of training, increasing public awareness of community colleges and their programs.

Yes

Marketing contact:

Yes

No (do not contact)

Preferred method of communication:

E-mail

Mail

Phone Call

Text