CRED Programs Registration
For questions & more information, contact Kathi at KIndelicato@SIJCC.COM
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Female
Male
Non-binary
Prefer not to answer
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Nationality
*
Asian
Black/African American
Hispanic Latino
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
White
2 or more race groups
Prefer not to answer
Age
*
18-20
21-25
26-30
31-35
36-40
40+
Education
*
High School Diploma
GED
Some College
Associates Degree
Bachelor's Degree
None of the above
Documents that verify NYC Identity (Please upload if possible) Choose one of the following:
*
Identification Card
NY License
USA Passport
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Documents that verify the eligibility for legal work (Please upload if possible) Choose one of the following:
*
Driver’s license
U.S. social security card issued by the Social Security Administration that is unrestricted and does not have any of the following phrases indicating restriction on it: NOT VALID FOR EMPLOYMENT, VALID FOR WORK ONLY WITH INS AUTHORIZATION, VALID FOR WORK ONLY WITH DHS AUTHORIZATION
Original or certified birth certificate issued by a county, state, municipal authority or outlying possession of the United States that bears an official seal
U.S. Citizen ID Card (Form I-197)
ID Card for the use of a Resident Citizen in the United States (Form I-179)
Valid employment authorization document issued by the DHS
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How did you come to learn about the CRED program?
*
Who referred you to enroll in this program?
*
Please choose one of the folliwng information session:
*
May 5th, 2pm, ZOOM
May 7th, 10am (for Staten Island Justice Center,) ZOOM
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