First Name:
*
Last Name:
*
Social Security Number:
If you do not enter a SSN, you will be assigned a student ID number.
*
Date of Birth: (mm/dd/yy)
*
Gender:
*
Male
Female
MAILING ADDRESS
Address:
*
City:
*
State:
*
Country:
Zip Code:
*
Phone: (i.e.
6173732400)
PERMANENT ADDRESS
(unless otherwise specified, this address will be used for billing and grade notification.)
Address:
*
City:
*
State:
*
Country:
Zip Code:
*
Phone: (i.e.
6173732400)
E-mail:
*
The United States Office of Civil Rights requires that schools report enrollment by selected minority groups. This is to determine compliance with the Civil Rights Act of 1964 and continued eligibility of Northeastern University for federal funds such as student financial aid.
*
Race or Ethnic Group:
American Indian, Alaskan Native
Black, Non-Hispanic
Asian or Pacific Islander
Hispanic/Latino(a)
Foreign National
White, Non-Hispanic
Do Not Wish to Respond
*
Student Status:
Returning Student
New Student
New Student (not seeking degree or certificate)
*
Current School or Institution:
Course Registration:
Key#
(optional)
Course#
Course Name
Campus
Day
Time
1
2
3
4
5
