Contact Information

First Name:*

Last Name*

Email Address*

Confirm Email Address*

Home Phone

Cellphone

Can we text you?

Do Not AllowAllow

Cell provider

Birth Date (mm/dd/yyyy)

Legal Sex

Are you a U.S. Military Veteran?

YesNo

Are you currently U.S. armed forces active duty personnel or U.S. armed forces reservist?

YesNo

Are you a dependent of a U.S. Military Veteran?

YesNo

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Preferred Pronoun, Preferred First and Last Name may be used for mailings, academic communications, class rosters, etc.

Gender identity

Preferred pronoun

Preferred First Name

Preferred Last Name

International Student?

Check if address is outside of U.S. or Canada

Address

City

State/Province

ZIP/Postal Code

Country

Academic Area*• Undergraduate – high schools students, traditional-aged re-entry, transfer students, and prospective college students
• Bachelor Completion – prospective adults interested in online courses. Includes RN to BSN completion.
• Graduate – prospective students with undergraduate degrees looking to advance to a master’s degree

• Undergraduate – high schools students, traditional-aged re-entry, transfer students, and prospective college students
• Bachelor Completion – prospective adults interested in online courses. Includes RN to BSN completion.
• Graduate – prospective students with undergraduate degrees looking to advance to a master’s degree

Academic Program*

Academic Level*

Entry Term*Definition of Terms: Spring = January, Fall = August, Summer = May

Definition of Terms: Spring = January, Fall = August, Summer = May

Admit Type*Please select Reentry for Admit Type If you were previously enrolled in the Academic Program of Interest that you will be selecting on this form and plan on returning to complete the same Academic Program.
**A freshman student is one who will be enrolling in college for the first time (regardless if they have college credits earned while in high school).

Please select Reentry for Admit Type If you were previously enrolled in the Academic Program of Interest that you will be selecting on this form and plan on returning to complete the same Academic Program.
**A freshman student is one who will be enrolling in college for the first time (regardless if they have college credits earned while in high school).

Account Information

Password*

Confirm Password*

Password Question*If you forget your password, we will ask you this question in order to reset it.

If you forget your password, we will ask you this question in order to reset it.

Password Answer*If you forget your password, you must provide this answer in order to reset it.

If you forget your password, you must provide this answer in order to reset it.

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