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Primary Address
 
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Secondary Address

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Gender*
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Ethnicity*
Birthdate*

99/99/1999
NSHE ID
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Username: minimum 6 characters
Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)
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I.D. Type
I.D. Type-Other
Mail preference
May we include you on our mailing lists?
Yes No
Social Security Number or Individual Taxpayer Identification Number (ITIN)

Required for ESL or HSE applicants
Employment Status
Barriers to Employment

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If you are seeking employment, in what area?

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Highest Education Level
Country of schooling
Native Language
If you are requesting English as a Second Language classes, what type?
Ex-Offender?
Specific Learning Disability
Miscellaneous (Select one or more if applicable to you)

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GED/HSE/HiSET Area(s) You have Passed

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Would you like a CSN admissions counselor to contact you about continuing your college education?
No Yes
Do you have internet access at home?
Yes No
Type of computer you have at home

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