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NEC Class Registration
DPOR Information Form (missing or inaccurate information may delay approval)
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Email *
Please choose a class method: *
Required
Please check the appropriate box for Online classes only: (Classroom use other registration form) *
Required
Date of Class: *
Full Name: (First, Middle, Last) *
Gen. (Jr,  Sr, III, etc)
Street Address: *
Apartment/Unit#
City: *
State: *
Zip Code: *
Home Phone: *
Alternate Phone:
License Number: *
VA Driver# *
Birth Date: *
MM
/
DD
/
YYYY
Please read the Student's Instructions: (for online students only)
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