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STUDENT INFORMATION UPDATE

Registrar’s Office
1301 Main Street
Trenton MO 64683
(660)359-2211
registrar@mail.ncmissouri.edu

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Returning students who have been absent from NCMC for at least one semester, but less than five years, and who did not graduate from NCMC are required to complete and submit this form prior to enrollment, and no later than the Friday prior to the intended term of re-enrollment. Students returning, after completion of a degree or certificate at NCMC, must complete a re-admittance form with the Admissions Office.

Social Security Number:


Student Id#:


Legal Name:
(Last, First, Middle Initial, Maiden/Prior)


Permanent Address:
(# & Street, PO Box or Apt#)


(City, State, Zip, County)


Primary Phone:


Alternate Phone:


Email:


Birth Date:
(mmddyyyy)


Emergency Contact:
(Last, First, Relationship, Phone Number)


 

Residence Correction:
Tuition fees are based on a student’s permanent residence as defined by Missouri Dept. of Higher Ed. A separate form to request a change from previous records may be required, along with supporting documentation. Please contact the Registrar’s Office for information. Reduction of tuition rate may not be processed with this form.


Term you plan to return to classes at NCMC (mark only one):

Fall   Spring   Summer  
Year:20____

Term or date you last attended NCMC:
(If longer than 5 years, a Re-Admittance Form is required)



E-Sign Act
Please choose to accept or decline to authorize receipt of electronic records and all electronic transactions completed between North Central Missouri College and you, an NCMC student. If you decline, all communication will be through paper records. You may experience processing delays. Your acceptance authorizes all electronic transactions while an NCMC student, including registration and payment online.

 Accept   Decline

Universities, College, & Vocational Technical Schools Attended:

Please request transcripts for any coursework taken since your last attendance at NCMC. Official transcripts must be received no later than the Friday before the beginning of the term enrollment is intended. Send to Admissions at:

North Central Missouri College

1301 Main Street
Trenton, MO 64683

1.University/College/Vo-Tech


City & State


Credits Earned


Years Attended
(YYYY – YYYY)


 

2.University/College/Vo-Tech


City & State


Credits Earned


Years Attended
(YYYY – YYYY)


 

3.University/College/Vo-Tech


City & State


Credits Earned


Years Attended
(YYYY – YYYY)


 

Declaration of Degree and Program of Study:

Students should consult the current college catalog before declaring a degree and program of study.

I choose to be non-degree seeking: 
OR
 Associate in Arts (Indicate interest area ________________________________________)
OR
 Associate in Arts in Teaching
OR
 Associate in General Studies (not available for students who have completed an AA, AAT or Bachelor’s Degree)
OR
 Associate in Applied Science (Indicate program of study below)

 Agriculture & Natural Resources
 Applied Technology (1+1 w. Tech Sch.)
 Business & Technology, Business Management
 Business & Technology, Technology
 Computer Science & Information Systems
 Criminal Justice
 Dental Hygiene
 Diagnostic Medical Sonography
 Early Childhood Development
 Emergency Med Tech/Paramedic
 Industrial & Energy Systems Technology
 Medical Assistant
 Nursing
 Occupational Therapy Assistant
 Pharmacy Technology
 Radiology Technology
 Surgical Technology

OR
 Certificate (Indicate program of study below)

 Accounting/Business Tech
 Business Management Essentials
 Business Technology Essentials
 Criminal Justice
 Crop Production
 Equine Management
 Industrial & Energy Systems Technology
 Industrial Maintenance Skills
 Manufacturing Skills
 Marketing Management
 Practical Nursing
 Pharmacy Technology

Signature:


Date:


Return by mail, in person, or scan into email from your NCMC-issued, pirate email no later than the Friday prior to the beginning of the intended term of re-enrollment.


Office Use:
Term, YR:_____________
Advisor Assigned:


Date:


NCMC is committed to assuring equal opportunity to all persons and does not discriminate on the basis of race, color, national origin, sex, disability, religion, age, genetic information, veteran status, ancestry, gender identity or expression, or sexual orientation in its educational programs, activities, admissions, or employment practices as required by Title IX of the Education Amendments of 1972, Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Americans with Disabilities Act, other applicable statutes and college policy. Sexual harassment, to include sexual violence, is a form of sex discrimination and is prohibited. Inquiries concerning these statutes and nondiscrimination policies should be referred to the Dean of Student Affairs, Dr. Kristen Alley, Alexander Student Center, 1301 Main Street, phone extension 1400 or kalley@mail.ncmissouri.edu.

North Central Missouri College’s consumer information is available for your review at http://www.ncmissouri.edu/consumerinfo/. Paper copies of consumer information are available upon request to the Dean of Student Affairs at (660) 359-3948.

R 07/17/17