CLIP RECRUITMENT - CENTRAL

CLIP RECRUITMENT FORM

Please note: Only students who have been accepted to a CUNY college can enroll in CLIP.

Instructions:

Enter information for every part of this form or you will not be able to submit it.
Make sure you enter the same information that is on your CUNY Admissions Application.

Choose the time of day you can and want to attend CLIP*

Day Evening

Send From Email

CLIP PROGRAM SITE OF INTEREST

Choose the CLIP campus program that you want to enroll in.*

Central*

Y N

Personal Information

Enter your CUNY EMPLID*

The CUNY EMPLID is the number you received by email or mail after being accepted to CUNY.

Date of Birth (mm/dd/yyyy)*

two digit month/two digit day/four digit year

Name*

First Name

Initial (optional)

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Cell Phone*

Home/Other phone (optional)

Email Address*

Confirm Email Address *

Please note that submitting this form is the first step to enroll in CLIP. You will be contacted by the CLIP campus program you want to attend in response to your interest to enroll in CLIP.

Submitting the form does not mean that you are enrolled in CLIP.