Participant Information Form

Congratulations on your decision to register for a course with SUNY Corning Community College's Workforce Education and Academic Pathways. We look forward to working with you!

Please include the full name of the course.
Enter the dates of the course you selected
where course meets
Where does your selected course meet?

SUNY COVID-19 Vaccine Policy: All students who are participating in in-person learning at SUNY campuses and its facilities must show proof of vaccine, or submit a medical or religious exemption. If you submit the medical or religious exemption form, it must be submitted at least 3 business days prior to the start of the course.

Upload COVID-19 Vaccination Information

Complete Medical Exemption Form

Complete Religious Exemption Form
What is your legal name?

When completing the application we recommend that you use your legal name to ensure accurate and timely processing of required documents. 

Chosen Name Note: To use your chosen name, once you are a student at SUNY Corning Community College, follow the instructions at: Chosen Name page
If you have SUNY CCC educational records under a different name, please give former name.
what is your physical address?
what city/town do you live in?
what state do you live in?
what is your 5-digit ZIP code?
what is your cell/mobile number?
Text Permission
I give permission for the college to text me with important information related to my attendance
Do you have a work phone number?
What is your email address?
Please indicate your employer for our records. We will not contact your employer.
Please list your employer for our records. We will not contact your employer without your permission.
What is your official date of birth?
Gender*
Are you a US citizen?*
Are you a citizen of the United States of America?
If you are not a US citizen, what country are you a citizen of?
Are you Hispanic/Latino?
Are you Hispanic/Latino?
If Hispanic/Latino, is your background (select one):
If Hispanic/Latino, is your background (select one):
All students, please indicate your race background (select one or more):*
please indicate your race background

***If you have questions about the use of this information, please contact the Office of Workforce Education at 607-936-5501***

The Personal Privacy Protection Law requires this notice to be provided when collecting personal information from individuals. The authority to request this information is found in section 355 (2) (i) of the Education Law.  

Cancellation and Refund Policies:  

Cancellations will be determined 3 days prior to start date.  Should SUNY Corning Community College’s office of Workforce Education and Academic Pathways cancel a course, refunds are automatically generated. Students may cancel and request a full tuition refund anytime up to 48 hours prior to the start of class. Last minute cancellations by a student or failure to attend will NOT qualify for a refund. Students should make a cancellation request in writing, by email to ilearn@corning-cc.edu, or by phone to 607-936-5501, and should request confirmation of their cancellation. In cases of inclement weather or other emergency conditions, call 607-962-9222 for college closure information.