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Complete Vaccine Survey
Complete Vaccine Survey
AE Form Web Part
Banner ID:
First Name:
Last Name:
Email:
Are you working remote or in-person during the current semester?:
*
In-Person
Remote
Have you received the COVID-19 Vaccine?:
*
Yes
No
Decline to State
Please upload a legible picture of your valid, CDC issued vaccination card:
Maximum file size is 2MB. Please submit as a PDF, Word, Excel, JPEG, or PNG file.
All employees are required to wear masks indoors at all three campus locations.
*
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Please
stop
and
read
the following message before continuing to the Noncredit application! If you complete this
noncredit application
you
will not
be able to register for a credit course.
Noncredit classes are NOT degree applicable, CSU/UC transferable, or credit certificate applicable.
If you want to be able to take credit classes, please go to the
credit application here
.
Noncredit applications serve our English as a Second Language (ESL) community among other specialized noncredit certificates. Upon completion of your noncredit course(s) a certificate is awarded.
Click here to continue to the Noncredit Application