Application Form (NEW STUDENTS ONLY)

If you are registering ONLY for online courses do NOT fill out this form. Please complete this one instead.

Questions Please contact the Records & Registration Office at (928) 524-7459 | email | FAX (928) 524-7461.

1
Current: About You
2
Residency
3
Education
4
Goals
5
Information
6
Signature
7
Complete

Welcome! If you have NEVER attended Northland Pioneer College, please provide us with the following information. If you have attended (perhaps as a dual enrollment or NAVIT or NATIVE student), please call the Records & Registration Office (800) 266-7845, ext. 7459 to confirm your student contact information.

Title

First Name

Middle Name

Last Name

Your Legal Last Name

Suffix

Jr., Sr., II, III etc.

Other Names Used

Such as a Maiden, or Previous Married Last Name(s)

Personal Email

NPC will NOT give or sell your email addresses to anyone. We will only send you important enrollment information. NPC will provide you with an official student email account after registering for classes.

Please re-enter your email address

Mailing Address

Where the U.S. Postal Service delivers your mail.

Physical Address

Street address IF different from above

City/Town

State

ZIP/Postal Code

Telephone

A number, including Area Code, where we can reach you during regular business hours.

Ext:

Date of Birth

(Approval process is required for applicants under the age of 14 and certain course requirements for applicants under the age of 18.)