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Information Please enter your full first name, middle name and last name, rather than using initials.

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Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Enter your complete mailing address and phone number.

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Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Information Enter the email address which you use primarily.

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E-mail Address:
Verify E-mail Address:

Information Select your gender.

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Gender: Male Female Not Specified

Information Enter the Month, Day and Year of your birth.

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Date of Birth:Required Month Day Year (YYYY)

Information Enter the code for the high school from which you graduated or will be graduating by selecting the "Lookup High School Code" link.

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Home Schooled (check for yes):
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High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Information Select the Major you are interested in learning more about.

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Major:

Information What semester are you interested in enrolling at NSCC?

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Term of Entry:Required

Information Please tell us how you learned about Northwest State.

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How I Learned About Northwest State Community College Banner Self Service:

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Release: 8.7.2