College Now Application

Please complete the College Now application if you are interested in taking taking courses through the College Now program with Herkimer College.

*Indicates required field.

First Name*

Middle Name*

Last Name*

Preferred First Name

Address*

Country

Street

City

Region

Postal Code

Phone*

Your Email Address*

Parent's Email Address

Birthdate*

Legal Sex*

Gender*

Primary Citizenship*

Social Security Number (omit dashes) or Immigration Number

Herkimer ID number (if you have previously taken CN courses)

Is English your native language?*

Yes

Please select one or more of the following groups in which you consider yourself to be a member (select one or more by using the control key) *

Which best describes your American Indian or Alaska Native background? (select one or more by using the control key)

Which best describes your Asian background? (select one or more by using the control key)

Which best describes your Black or African American background? (select one or more by using the control key)

Which best describes your Hispanic background? (select one or more by using the control key)

Which best describes your Middle Eastern or North African background? (select one or more by using the control key)

Which best describes your Native Hawaiian or Other Pacific Islander background? (select one or more by using the control key)

Which best describes your White background? (select one or more by using the control key)

High School Attending*

Expected High School Graduation Year*

What is your career goal? (This will help us provide courses that are beneficial and align with your goals!)

Course Registration

Course

CRN Number

Course

CRN Number

Course

CRN Number

I understand that withholding information requested on this application, including giving false information, may result in denial of admissions or dismissal. I have read this application and certify that the information I have provided is correct and complete.*

Yes

By submitting this form, I consent to receiving calls, texts, and/or emails from Herkimer County Community College.