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Create New Student Profile

The following information is required so that we can successfully register you and process certificates when you complete a course.

*You may use an email address as your Username.

* denotes required information.

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E-mail*

You will use your email address as your username on this site.

Re-enter E-mail*

Password*

Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)

Strength

Re-enter password*

Password hint*

Identity Verification Question*

Identity Verification Answer*

First name*

Middle Name

Last name*

Birth / Other Name

Maiden Name

Primary Address

Primary Address Type*

Country*

line 1 > Address*

line 2 > Address

City*

State*

Province *

Zip*

Zip+4

Secondary Address

Same as Primary Address

Secondary Address Type

Country

line 1 > Address

line 2 > Address

City

State

Province

Zip

Zip+4

Phone*

Additional phone

Gender*

Male
Female
Prefer Not to Answer

Date of Birth*

Cancel

Drivers License Number

Social Security Number

Race*

Ethnicity*

Educational Level*

Resident

Yes No
Are you a local resident or meet residency status?

Employed?

Are you currently employed?

Are you a Veteran?

‘Click-Ctrl’ to select multiple options

By clicking this box, you are confirming that you have been negatively impacted by COVID-19.

I have been negatively impacted by COVID-19
(In order to access MJRP funding, this box needs to be checked.)

Cancel

Mail preference

May we include you on our mailing lists?

Yes No

Center Compact Member (BI Code)

Employer

The company you work for.

Cancel

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