Thank you for your interest in the Olympic College CTETeacher Certification Program.

Step 1. Please fill out page one “CTE Teacher Certification Program Registration Form.”

Step 2. If you do not wish to disclose your Social Security Number on the “CTE Teacher Certification Program Registration Form,” you are required to fill out the “Request for Student’s Taxpayer Identification Number” form. When doing so please fill out Part 1 and Part 3 in their

entirety while marking the appropriate box in Part 3 This form also requires your hand written signature.

Step 3. This package is made to be filled out electronically. After doing so, save the document as your name and then attach it to an email. The package is also designed to be printed in a five page format to either scan(and email) or fax. Once you have completed the forms package in its entirety, send it via your preferred method:

via email to: TeacherCTECert@olympic.edu,

or

via secure fax to: 360.473.2830

or

via post to: CTE Teacher Certification Program

CSC 421

1600 Chester Ave

Bremerton WA., 98337-1699

If you have any questions or concerns that apply to this process, please email:

TeacherCTECert@olympic.edu

CTE Teacher Certification Program

Registration Package

First Name

Zip Code

Last Name Address City Day telephone

State

Are you the first generation in your family to go to college? Yes No

Which race do you consider yourself to be? (This question is optional. The information is used for statistical purposes only.)

American Indian or Alaska Native (597) What is the name of your enrolled or principal tribe:Black or African American (872) Chinese (605) Filipino (608) Japanese (611) Korean (612) Native Hawaiian or Pacific Islander (653) Vietnamese (619) White (800) Other Asian (621) Other Pacific Islander (681) Other Race (799) Specify:

Are you of Spanish or Hispanic origin? No (999) Mexican, Mexican American, Chicano (722) Cuban (709) Other Spanish/Hispanic/Latino Specify:

Is English your first language? Yes No

Are you a US Citizen? Yes No If not, country of citizenship.

I certify to the best of my knowledge all statements on this form are true. Admission to OC carries with it the expectation that students agree to comply with established OC policies and regulations. If submitting electronically, your typed signature below indicates acceptance of the previous two sentences.

Print Name Signature Date

Enrollment Form 20171017

E mail

Social Security Number - - Your social security number is confidential and, under federal law

called the Family Educational Rights & Privacy Act, the College will protect it from unauthorized use and/or disclosure. In compliance with state/federal requirements, disclosure may be authorized for the purposes of state and federal financial aid, Hope/Lifetime Learning tax credits, academic transcripts, or accountability research. A College ID number will be assigned for use in all future College transactions other than those listed above.

Date of Birth (MM/DD/YYYY) Gender Identity

CTE Teacher Certification Program Registration Form

Evening telephone

Item Number Course ID Item Number Course ID Item Number Course ID

1. Select the desired quarter you wish to start

2. Select "Continuing Education" for "Include Classes"

3. Select the "CTE Teacher Certification" button

4. Find the "Item" number and ID of the class for your first enrollment(s) and record them below

To find your first class for enrollment, go to: https://apps.olympic.edu/classschedule/Default.aspx

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Request for Student’s Taxpayer Identification Number (Substitute Form W-9S)

Return completed signed form, in person or by mail, to: Registration and Records

1600 Chester Avenue, Bremerton WA 98337

Do not submit this form to the IRS.

Complete the form in blue or black ink.

Part 1

Last Name

Taxpayer Identification Number (SSN or ITIN)

Street Address

First Name

City State

OC Student Identification Number

M.I.

Zip Code

Part 2

By my signature below, I certify that the number shown on this form is my correct SSN/taxpayer ID number.

Signature Date

~~~ OR ~~~

I am a foreign national, nonresident alien, or International student and do not have a Social Security number or Individual taxpayer ID number. I do not plan to file an income

tax return in the U.S.

I am unable to, or choose not to provide my SSN/ITIN to Olympic College at this time. I understand that I may be subject to an IRS fine for failure to do so. I further under

stand that the IRS will not be able to use the Form 1098-T filed by Olympic College to confirm my eligibility for certain education tax benefits without my SSN/ITIN.

Part 3

Signature Date

Instructions

Purpose: Olympic College must get your correct identifying number to file the Form 1098-T, Tuition Statement, with the IRS and to furnish a statement to you. This will be your social Security number (SSN) or your individual taxpayer identification number (ITIN). Form 1098-T contains information about qualified tuition and related expenses to help determine whether you, or the per-son who can claim you as a dependent , may take either the tuition and fees deduction or claim an education credit to reduce fed-eral income tax. For more information, see IRS Pub. 970, Tax Benefits for Higher Education. Under Federal law, you are required to provide the requested information.

Part 1. Enter your name and mailing address. The name should match that used by the Social Security Administration or Internal Revenue Service. Taxpayer identification number - Enter your SSN or ITIN. Please include your OC student ID number.

Part 2. Sign your name in the space provided to confirm the information provided. The registrar cannot change your records without your signature.

Part 3. Please fill out this part only if you choose not to or are unable to provide the SSN/ITIN. Check either the first or the second box and sign the statement. By law, Olympic College must ask you at least once a year for your taxpayer identification number in order to meet its obligation to file Form 1098-T.

Deliver, or mail the completed form using the enclosed postage paid, self-addressed envelope to Registration and Records. Please do not email the form. Email is not a secure way to transmit personal information. Forms also cannot be accepted via fax.

Misuse of SSNs. If Olympic College discloses or uses your SSN/ITIN in violation of Federal law, Olympic College may be subject to civil and crimi-

nal penalties.

Privacy Act Notice: Section 6109 of the Internal Revenue code requires you to give your correct SSN or ITIN to persons who must file infor-

mation returns with the IRS to report certain information. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation and to cities and states to carry out their tax laws.

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