Prospect Data Entry Form

Greetings from the admission staff at NECC!

We are available Monday - Friday 9:00am - 5:00pm to answer any questions you may have.

You can reach us at any of the following:

Phone: (978) 556-3700
Email: enrollmentservices@necc.mass.edu

Check out the Information Sessions and Tours

- indicates a required field.

When would you like to start?
Term of Entry:

Name Information
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Nickname:

Address Information
Valid From:	Month Day Year (YYYY)
Until:	Month Day Year (YYYY)
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number:	- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Birthdate
Date of Birth:	Month Day Year (YYYY)

E-Mail Information
E-mail Address:
Verify E-mail Address:

Interest in a specific major?
Major:

To find your high school , Click the "Look Up High School Code" and follow the instructions.
Do not type in the high school name box. The High School Name will populate once you select the High School from the drop down list.

High School Information
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date:	Month Day Year (YYYY)
Class Rank and Size:	/ (must be numeric)
GPA:	(example: 9.99, or A+)

To select multiple interests (up to 5) use Ctrl+Click for PC and Command+Click for Mac.

Tell us about your interests?
Interests:

Data Protection Statement for Requesting Information from NECC

Please review the Data Protection Statement for requesting information and select your consent option below.

Citizenship Information
Citizenship:

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Prospective Student Information

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