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New Student Registration

New Student information
Name Prefix
First Name*
Middle Intial
Last Name*
Name Suffix
Date of Birth* (mm/dd/yyyy)
Gender
Telephone*

 

Email Address / Notification
Email Address
Comfirm Email*

 

Address / Residency
Street*
City*
State*  
Zip Code*

 

Citizenship Status*
U.S. Citizen
Permanent Resident
In U.S. on Visa
Other

 

Ethnicity
Are you from one or more racial groups? (Selest all that apply)
Hispanic  
Asian
White
Black
Native
Native Hawaiian
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Education Plans*
Pursue a DEGREE in Arts
Pursue a DEGREE in Applied Science
Earn a Certificate
Take Classes only-Class Category

 

Term you will begin*
My Intent please comment:
By checking this box: I certify the above info is true