Continuing Education Application

Class Title(Required)
Class Start Date(Required)
Month
Day
Year
ECC Student ID Number
First Name(Required)
Middle Name
Last Name(Required)
Address(Required)
City(Required)
State(Required)
Zip(Required)
County of Residence(Required)
Email Address(Required)
Enter Email Confirm Email
Home Phone(Required)
Work Phone
Cell Phone
Date of Birth(Required)
Month
Day
Year
Race(Required)
Race Other
Gender(Required)
- Male
- Female
Student Type(Required)
- Firefighter (Paid)
- Firefighter (Volunteer)
- Rescue Squad (Paid)
- Rescue Squad (Volunteer)
- First Responder (Paid)
- First Responder (Volunteer)
- Law Enforcement
- Inspector (fire/bldg/mech/elec/plumb)
- Inmate
- ECC Full-time Employee
- Other
Select all that apply.
Employment Status(Required)
Are you a student who is currently enrolled in high school?(Required)
- Yes
- No
High School
Highest completed level of education(Required)
Citizenship(Required)
- US Citizen
- Permanent Resident Alien
- Alien Authorized to Work
- Other
Citizenship Other
Name of Employer
Job Title
How did you hear about this class?
- Newspaper
- Flier
- Email/Newsletter
- ECC Website
- Facebook
- Instagram
- Twitter
- Friend or Coworker
- US Postal Service/Mail
- Other
Authorization
- I grant permission to Edgecombe Community College to use my image and/or quotes for any use the college deems appropriate in the promotion and marketing of the college through print and electronic media. I also agree that the North Carolina Community College System my use my image and/or quotes to promote community college services throughout the state.
- I hereby give permission to Edgecombe Community College and the NC Department of Community Colleges to release my grades/transcripts to the following credentialing agencies and affiliated chief officer of my agency/department: NC Department of Insurance Fire/Rescue Commission, NC Criminal Justice Training & Standards Commission, NC Sheriff's Training & Standards Commission, NC Office of Emergency MEdical Services, Student's Affiliated Agency/Department of Chief Officer (Written Request)
Guidelines for COVID-19 Symptoms or Positive Test(Required)
I confirm that I have reviewed these guidelines.
Edgecombe Community College has established guidelines for COVID-19 symptoms or positive test. Please confirm you have reviewed these guidelines before submitting this form. View Guidelines
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Continuing Education

Continuing Education Application

Continuing Education Student Application