2017-18 NC State University NC-MSEN Pre-College Program Registration Form
The NC-MSEN Pre-College Program at NCSU provides STEM enrichment and college preparation for underserved students in grades six through twelve. For the 2017-18 school year, there will be a registration fee of $100 per student to participate in our program; $50 fee for students who are on free/reduced lunch. The fee and other required documents are due on September 21. This form should be completed by students who participated in MSEN during the 2016-17 school year (including the summer) or for students who have been admitted into our program for the 2017-18 school year at the following schools: Broughton HS, Carnage MS, Centennial Campus MS, Ligon MS, North Garner MS, SE Raleigh HS.
Email address
Last Name
Your answer
Middle Name
Your answer
First Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Race/Ethnicity
Home Address
Your answer
City
Your answer
Zip Code
Your answer
Home Phone Number
(Please use this format: (area code) xxx-xxxx)
Your answer
Free/Reduced Lunch Status
Does the student qualify for free/reduced lunch? Documentation must be provided to the MSEN Office at NCSU.
Career Interest
Number of previous years in MSEN
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