Workforce Non Credit Registration Use this form to register for classes offered through MECC's Center for Workforce Development. 名字。(必需) 第一个 中间 最后的。 电子邮件(必需) Student ID (If Known)(必需) Address(必需) 街道地址 地址线2 城市 State / Province / Region ZIP / Postal Code 阿富汗阿尔巴尼亚阿尔及利亚American 萨摩亚安道尔安哥拉安圭拉岛南极洲Antigua and Barbuda阿根廷亚美尼亚阿鲁巴岛澳大利亚奥地利阿塞拜疆巴哈马群岛巴林孟加拉国巴巴多斯白俄罗斯比利时伯利兹贝宁百慕大不丹玻利维亚Bonaire, Sint Eustatius and SabaBosnia and Herzegovina博茨瓦纳布维岛巴西British 印度n Ocean TerritoryBrunei Darussalam保加利亚布吉纳法索布隆迪佛得角柬埔寨喀麦隆加拿大开曼群岛Central African Republic乍得智利中国。Christmas Island科科斯群岛哥伦比亚科摩罗刚果刚果, Democratic Republic of the库克群岛哥斯达黎加克罗地亚古巴库拉索岛塞浦路斯Czechia科特迪瓦丹麦吉布提多米尼加多米尼加n Republic厄瓜多尔埃及萨尔瓦多Equatorial 几内亚厄立特里亚爱沙尼亚Eswatini埃塞俄比亚Falkland Islands法罗群岛斐济芬兰法国法属圭亚那French PolynesiaFrench Southern Territories加蓬冈比亚乔治亚州德国加纳直布罗陀希腊格陵兰岛格林纳达瓜德罗普岛关岛危地马拉格恩西岛几内亚几内亚比绍圭亚那海地Heard Island and McDonald Islands教廷洪都拉斯香港匈牙利冰岛印度印尼伊朗伊拉克爱尔兰马恩岛以色列意大利牙买加日本泽西岛约旦哈萨克斯坦肯尼亚基里巴斯Korea, Democratic People's Republic ofKorea, Republic of科威特吉尔吉斯斯坦Lao People's Democratic Republic拉脱维亚黎巴嫩莱索托利比里亚利比亚列支敦斯登立陶宛卢森堡澳门马达加斯加马拉维马来西亚马尔代夫马里马耳他Marshall Islands马提尼克岛毛利塔尼亚毛里求斯马约特岛墨西哥密克罗尼西亚摩尔多瓦摩纳哥蒙古黑山共和国蒙特塞拉特摩洛哥莫桑比克缅甸纳米比亚瑙鲁尼泊尔荷兰新喀里多尼亚新西兰尼加拉瓜尼日尔尼日利亚纽埃岛诺福克岛North MacedoniaNorthern Mariana Islands挪威阿曼巴基斯坦帕劳Palestine, State of巴拿马Papua New 几内亚巴拉圭秘鲁菲律宾皮特克恩波兰葡萄牙波多黎各卡塔尔罗马尼亚Russian Federation卢旺达团聚Saint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and Nevis圣卢西亚岛圣马丁Saint Pierre and MiquelonSaint Vincent and the Grenadines萨摩亚圣马力诺Sao Tome and Principe沙特阿拉伯塞内加尔塞尔维亚塞舌尔塞拉利昂新加坡它们Maarten斯洛伐克斯洛文尼亚Solomon Islands索马里南非South 乔治亚州 and the South Sandwich Islands南苏丹西班牙斯里兰卡苏丹苏里南Svalbard and Jan Mayen瑞典瑞士Syria Arab Republic台湾塔吉克斯坦Tanzania, the United Republic of泰国东帝汶多哥托克劳汤加Trinidad and Tobago突尼斯土库曼斯坦Turks and Caicos Islands图瓦卢TurkiyeUS Minor Outlying Islands乌干达乌克兰United Arab Emirates联合王国美国乌拉圭乌兹别克斯坦瓦努阿图委内瑞拉越南Virgin Islands, BritishVirgin Islands, U.S.Wallis and Futuna西撒哈拉也门赞比亚津巴布韦阿兰群岛 国家 Primary Phone Contact(必需)手机出生日期(必需) MM slash DD slash YYYY 经验丰富的 是的 No If yes, then please list branch and date of active status: 住院医生实习期(必需) US Citizen since birth Naturalized: Became US Citizen after birth Not a US Citizen/国家 of Citizenship 少数民族 白色。 Black/African American American 印度n Hispanic/Latino Native Hawaiian/Pacific Islander 亚洲 非特异性 Emergency Contact 第一个 最后的。 的关系 Emergency Contact Phone老板的电话My Employer is: Paying the course registration fee Reimbursing me for the course registration fee Neither -- I am responsible for the course registration fee 我的课程是: Directly related to my employment Not related to my employment Beneficial to acquiring new job skills/certifications Course Registration(必需) 秋天 春天 课程一年(必需) 科目名称(必需) Course Number and Section 课程日期 MM slash DD slash YYYY Course Time (If Known) 小时 : 分钟 AM / PM AM PM AM / PM Course Fee (If Known) Method of Payment Credit Card/Visa, Mastercard Only Bill My Employer Check or Money Order If paying by credit card, what is your contact number to reach you?If you are paying with check or money order, please mail to:Attn: Workforce Development 3441 Mountain Empire Road, 大石缝, VA 24219If employer is paying, please mail PO or Letter of Authorization to:Attn: Workforce Development 3441 Mountain Empire Road, 大石缝, VA 24219