* = Required Field

  • Contact Information
    Please enter your contact information
    • Enter your last name

    • [mm/dd/yyyy]
    • Select all that apply
      American Indian/Alaskan Native
      Native Hawaiian/Pacific Islander
      Cape Verdean
      Black/African American
      Choose not to disclose
    • (XXX) XXX-XXXX

    • YYYY

  • High School Information Remove Entry
    • If your high school is not listed, please type "unknown" and select from options

  • How Did You Hear About NSCC?
  • Text Message Opt-In/Out

    • By indicating below, I agree to receive phone calls and/or text messages from or on behalf of North Shore Community College regarding their products and services, at the phone number(s) provided on this form, including my wireless number. 

      I understand that these calls and/or texts may be generated using an automated technology.  
      **Please note, additional fees may apply as required by your telephone provider.


  • Mobile Number
  • Refer a Friend
  • Referral Information Remove Entry