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Fast Application for College Credit Plus Students

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First Name*

Last Name*

Birthdate*

Birthdate*

Legal Sex*

Gender

Student Email Address*

Cell Phone

I allow NDC to contact me via text message.*

I allow NDC to contact me via text message.*

Yes

No

Permanent Address*

Permanent Address*

Country

Street

City

Region

Postal Code

Social Security Number

Are you Hispanic?*

Are you Hispanic?*

Yes

No

Race/Ethnic Background*

Race/Ethnic Background*

Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

Choose Not to Respond

American Indian or Alaska Native, Asian

American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Black or African American

American Indian or Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Black or African American, White

American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, White

Asian, Black or African American

Asian, Black or African American, White

Asian, Native Hawaiian or Other Pacific Islander

Asian, Native Hawaiian or Other Pacific Islander, White

Asian, White

Black or African American, Native Hawaiian or Other Pacific Islander

Black or African American, White

Native Hawaiian or Other Pacific Islander, White

Current School Information

High School Name:*

High School Code (Hidden)

Level of Study (Hidden)

Intended High School Graduation Date*

Guidance Counselor Email Address*

Guidance Counselor First Name*

Guidance Counselor Last Name*

Parent/Guardian Contact Information

Relationship Type*

First Name*

Last Name*

Email*

Phone Number*

Do you live with this person?*

Do you live with this person?*

Yes

No

Please provide this Parent/Guardian's Address*

Please provide this Parent/Guardian's Address*

Country

Street

City

Region

Postal Code

Parent/Guardian Employer Name

CCP Enrollment Details

Semester/Year of entry:*

Where do you plan to attend your CCP Courses?*

CCP Permission Slip

**Please fill out and upload the following documents:

Permission Slip

*Upload Permission Slip:

CCP Terms & Conditions

Please read the Terms and Conditions for CCP and agree to the terms by checking yes below.

I attest to the fact that all information given on the online application is complete and correct and agree to the terms and statements included herein. Any intentional omission or falsification will result in denial of admission or immediate dismissal.

Person Status is Dual Enrollment (Hidden)

Student Type is Dual Enrollment (HIDDEN)

Major is Non Degree Seeking (Hidden)

Degree Type (HIDDEN)

Round (Hidden)

App Round Always Create (Hidden)

Application Submitted Flag (Hidden)

PIN Generation (Hidden)

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