COCAL/Individual Studies Interest Form

First Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Personal Email Address

Cell Phone

May we text you with important updates?

Yes

No

What is your career interest?

What is your educational background?

Special Skills. List any additional experiences; skills or personal qualities that you feel will be applicable to the career you are applying for. For example, volunteer, military, life experience, apprenticeship, etc.

Have you ever been convicted of a felony?

Yes

No

Previous Employer Section

Employer Name, Address & Phone Number

Permission is hereby given to the SUNY FMCC COCAL program to exchange with my sponsoring agency(ies) any academic/testing information associated with my participation in the Individual Studies/COCAL program. I also authorize the COCAL staff to consult with other faculty, staff and administrators about matters related to my success at FMCC. In addition, for the purpose of placement in a COCAL training site, I authorize COCAL staff to provide information to potential trainers for the purpose of assisting in my placement. This Release of Information will remain in effect for the duration of my participation and for any follow-up related to my participation. I also verify that all the information provided in this application is correct. COCAL has permission to verify all information provided.

I authorize the release and exchange of information.