Application for Early Entry Credit Courses

Start your College Career

Fill out this form to apply to take classes.

All fields are required

Step 1: Student Information

First Name:
Middle Name:
Last Name:
Address:
City:
State/Province:
Postal Code:
County Code:
Birth Date:   xx / xx / xxxx
Email:
We respect your privacy.
Gender:
Home Phone:   xxx-xxx-xxxx
Cell Phone:   xxx-xxx-xxxx
High School:
Graduation Date:   Month/Year xx/xxxx

Step 2: Nebraska Resident Status

Note: Be advised that answering Yes to any of the following questions does not automatically qualify you as a resident for tuition purposes. Northeast Community College reserves the right to require any application to submit residency documentation to determine residency status.

I claim to be a legal resident of Nebraska:
I have lived in Nebraska Continuously since:   xx / xx / xxxx
My parents/legal guardian(s) have lived in Nebraska Continuously since:   xx / xx / xxxx

Step 3: Parent/Guardian Information

First Name:
Middle Name:
Last Name:
Address:
City:
State/Province:
Postal Code:
Home Phone:   xxx-xxx-xxxx
Cell Phone:   xxx-xxx-xxxx
Email:
We respect your privacy.

Step 4: Racial and Ethnic Information

This information is optional to comply with federal guidlines and will not be used in determining admissions status:

Note: Please answer the following without regard to your race.

Ethnicity:
Racial Categories:

Is English your Primary Language?:
Have you ever served in the U.S. Military?:
Do you plan to use military educational benefits?:

Step 5: Course Selection Request

Term:
CRN Course #: Subject: Course: Course Title: Credit Hours: Instructor:






*Please note some courses require certain test scores and/or prerequisites.

 


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