NWMCC Online Student Information Form
Summer | Fall 2017 TERMS

After enrolling in an online class, please fill this electronic form out, then click submit to transmit your information to the eLearning department. If you have any questions about this form, please call us at 662-560-5230.

Full Name
Type your full name beginning with your LAST NAME followed by your FIRST NAME into the response box. For Example: Doe, John S.
Your answer
Northwest Student ID Number (Excluding the Zeros)
Enter your Northwest ID number WITH OUT the zeros in front. For Example: If your student ID is 00012345, you would only enter 12345.
Your answer
Semester Attending (Check all that apply)
Check any and all terms which you will be attending.
Required
Indicate which campus you are registering.
Mark only one.
Required
Indicate which ONLINE courses you are registering.
For Example: Course Code and Number with section (MAT1313 35).
Your answer
Cell Phone Number
Type the primary phone number you wish to be contacted at by your instructor, if necessary in the following format: 662-555-1234
Your answer
Personal Email Address; AOL, Yahoo, Gmail, Hotmail, iCloud, etc.
Be sure to include your email handle. For Example; @aol, @yahoo, @gmail, etc.
Your answer
Is this the first time you have taken an online class through Northwest?
Check which box applies.
Student Agreement
As an Online Student I understand and agree to the following; 1. During the semester, I will have consistent and reliable access to a computer with internet connection. 2. I understand that all online classes are reading intensive. 3. I have adequate time to devote to an online class. 4. I understand that online classes require self-discipline and time management skills. 5. I understand that all online classes require 1 to 3 proctored exams and I will be required to come to campus to take the exams with my instructor (if you can not meet your instructor, you will be required to come to the Senatobia campus to be proctored). 7. I understand that online classes also have an absentee policy and it is my responsibility to know how my instructor counts absences. 8. It is my responsibility to purchase the textbooks and software needed for my online class EVEN IF FINANCIAL AID AND/OR LOANS ARE NOT IMMEDIATELY AVAILABLE.
Hardware | Software Recommendations for Online Classes
* Windows 7, Windows 8.x, Windows 10 or MAC operating system. * Microsoft Office Products (Word, Excel, Power Point, etc.). * Desktop, or Laptop, with at least 4GB of RAM memory. * Pentium Dual Core Processor or Intel based MAC preferred. * High speed internet connection preferred (High speed Cable, High speed DSL). * Additional hardware/software may be required for some courses.
Electronic Signature
Please put your electronic signature (your initials) in this field which means you have read and understood the student agreement, and the hardware / software recommendations for online classes. Example John L Doe = JLD
Your answer
Students Date of Birth
Please put your electronic signature (your initials) in this field which means you have read and understood the student agreement, and the hardware / software recommendations for online classes. Example John L Doe = JLD
MM
/
DD
/
YYYY
Today's Date for 2017
Enter today's date using the drop down calendar provided.
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms