Students - New Profile

* = Required Field

Username *	Letters and numbers only
Password *	Letters and numbers only; leave blank if no change.
Re-enter Password *

1.	First Name *
	Last Name *
	Middle Name:
2.	Social Security Number *	(numbers only)
3.	Mailing Address *
4.	City *
	State *
	Zip Code *	(5 digits)
5.	Date of Birth *	(m/dd/yyyy)
6.	Birthplace City
6.	Birthplace State
7.	State of Residence *
7.	Country of Residence *
8.	Contact No. 1: *
8.	Contact No. 2:
9.	Personal Email *
9.	School Email
10.	Active CNMI Voting Affidavit #	Numbers Only
10.	Last election Year Voted
11.	Gender *	Male Female Not Indicated
12.	Citizenship *	U.S. Citizen Other: If other, please select:
13.	Ethnicity *	If Other/Other Pacific Islander, please indicate:
14.	Permanent CNMI Address *
	State *
	Zip Code *
	Village Residing *
15.	State of Legal Residence *
16.	Permanent CNMI resident? *	Yes No
17.	Are you on active duty with the U.S. Armed Forces? *	Yes No
17.	Active Service Commitment date	(m/dd/yyyy)
18.	Have you been continuously residing in the CNMI within the last two years (2013 and 2014)? *	Yes No If no, indicate: Location: Purpose: