Student Application Form – Cross Over Community Development

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If you are interested in COCD’s Career Bridge program, please complete the form below and someone will be in touch with you shortly to advise on next steps.

Student Application

Please complete the form below. Fields will be submitted securely to COCD.

First Name

Last Name

Date of Birth

Street/Address

City

State/Province

Zip

Country

Gender Preference

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Is this a mobile phone number?

Additional Information

If employed, where:

Do you need daycare?

Citizenship Status

Do you have wifi at home?

Acknowledgements

I understand that I will take assessments for placement into the appropriate level based on my current abilities. I have read COCD’s Core Values. I have read and agree to abide by COCD’s Code of Conduct. I have read and understand COCD’s Safeguarding Policy, Protocol, and Resolution. I agree to support COCD’s Program Guidelines and Policies.

Thank you for applying.