NEW DA, IT , MT, NA, AP, EMT, AU, GR

DA, IT , MT, NA, AP, EMT, AU, GR - Registration Form

Enroll in

Program

Payment Options

Dental Assistant: Level I: Full Payment: $4100, Payment Plan Available: $500 to start
IT Fundamentals: Full Payment: $995, Medical Terminology: Full Payment:$600
Nurse Assistant: Long Term Care: Full Payment: $2150, Payment Plan: $500 to start Anatomy and Physiology : Full Payment $850
EMT: Full Payment $995 Auto Tech: Full Payment $995 Graphic Design: Full Payment $995

Payment Plan

Default Payment Plan for Invoice

First name

Middle Name

Last name

Have you ever attended an educational institution with another name? (i.e. maiden name, nickname, etc)

Street

City

State/Province

Zip/Postcode

Birth Date

Gender

Cell Phone

Home Phone

SMS

Race

What type of student are you?

New Student (I have never taken an adult or high school course through NOCROP)

Returning Student (I have taken an adult course through NOCROP more than one semester ago)

Continuing Student (I have taken an adult NOCROP course within the past semester)

Transitioning High School Student (I have taken an ROP course in high school, but this will be my first adult NOCROP course)

Unsure (I am not sure what student category I fall into)

Required

This question allows NOCROP to collect your Social Security Number and ITIN and share it with the California Department of Education who will share your personal information with the Employment Development Department.The Employment Development Department is the state agency responsible for maintaining personally identifiable information, and keeps all information confidential it receives from the California Department of Education for use only to track the labor market outcomes of adult education program participants in compliance with all applicable state and federal laws and mandates.

Social Security No

Emergency Contact Information

Contact Name

Relationship

Cell Phone

Demographics

Yearly Household Income

Education and Training

Ethnicity

What is your secondary goal?

If not applicable, please choose

Marital Status

First Language

Family Size

Work Status

If other, please specify

Highest year of school completed

What high school did you attend?

Leave blank if not applicable

Were most of the school years completed outside the US?

Yes No Not Selected
school years

Did you take an ROP course in high school?

Refund Policy Agreement

Please read the NOCROP Refund Policy Please note: Course start is based on student enrollment. If the minimum number of students necessary to operate the course is not met, the course may be either postponed or canceled..

I have read and agree to the NOCROP Adult Education Refund Policy

Date

Date of Refund Policy Acknowledgement

Waiver Release Information

I understand that this course may require me to perform certain activities that include, but are not limited to, the following: considerable standing, heavy lifting, repetitive hand and arm motions that may cause or exacerbate any pre-existing auto-immune, muscular, joint, cardiovascular, neurological and/or orthopedic conditions. Knowing the risks of such activities, nevertheless, I hereby agree to assume those risks and to release and hold harmless the North Orange County Regional Occupational Program, its governing board, officers, employees, agents, and/or representatives who might otherwise be liable to me (or heirs or assigns) or damages.

I agree to accept and abide by the rules and regulations of the North Orange County Regional Occupational Program with respect to my participation in the above referenced course.

Yes, I agree

Admission Policies

A copy of the NOCROP Admission Policies can be viewed here. Please read them before proceeding.

Do you agree to the NOCROP Physical Contact and Graphic Images Consent and Release?

Yes, I agree

Do you agree to the NOCROP Student Use of Electronic Resources and Technology Agreement?

Yes, I agree

Do you agree to the NOCROP Patient Care Training Programs Consent and Release?

Yes, I agree

Do you agree to the NOCROP Student Handbook Agreement?

Yes, I agree

Do you permit North Orange County ROP, and organizations, consortiums, and associations connected with it to represent the student named below, in photograph(s), video recordings, and with interview comments for use in educational, promotional, and publication purposes?

Yes No Not Selected

Date of Acknowledgement of NOCROP Admissions Forms

Today's Date

NOCROP Privacy Policy Agreement

Click to read the NOCROP Privacy Policy

Do you agree to the NOCROP Privacy Policy?

Yes, I agree

IMPORTANT INFORMATION

After you click "Submit Application", you will be taken to the next page to select your course. After, you will be able to pay for your first installment, or entire payment, based on your choice. Your spot will not be secured in the course, unless payment is made.

How did you hear about us?

Enter the above code

Required