Distance Learning Student Information Form
(Complete the form below, and click the Submit button at the bottom of the screen.)
* First Name:   *Last Name:
*Last four(4) digits of Social Security Number or Student Number:
*Telephone Number:   Second Phone Number:
*E-Mail Address:   Current GPA:
*Mailing Address:  *City:  *State:  *Zip Code:

*Course Title:
(Please select all of the distance education courses that you are enrolled in.)
ACT141 - Basic Accounting Principles
ACT142 - Advanced Accounting Principles
ART100 - Art Appreciation
ART173 - Photography I
ART174 - Photography II
ART203 - Art History I
BIO103A - Principles of Biology I
BIO104A - Principles of Biology II
BUS263 - Legal & Social Env of Business
BUS271 - Business Statistics I
BUS272 - Business Statistics II
BUS285 - Principles of Marketing
CHD100 - Intro to Early Care and Education of Children
CHD201 - Child Growth & Development Principles
CHD205 - Program Planning for Educating Young Children
CHD206 - Children's Health & Safety
CIS110 - Intro to Computer Logic & Programming
CIS146 - Microcomputer Applications
CIS147 - Advanced Microcomputer Applications
CIS148 - Post Advanced Microcomputer Applications
CIS191 - Intro to Computer Science
CIS249 - Microcomputer Operating Systems
CIS255 - Java Programming
COS111 - Cosmetology Science & Art
COS124 - Salon Management
COS131 - Aesthetics
COS167 - Cosmetology State Board Review
COS168 - Bacteriology & Sanitation
CRJ100 - Introduction to Criminal Justice
CRJ110 - Introduction to Law Enforcement
CRJ208 - Introduction to Criminology
DDT117 - Manufacturing Processes
ECO231 - Principles of Macroeconomics
ECO232 - Principles of Microeconomics
ENG101 - English Composition I
ENG102 - English Composition II
ENG271 - World Literature I
ENG272 - World Literature II
HED226 - Wellness
HED231 - First Aid
HIS101 - Western Civilization I
HIS102 - Western Civilization II
HIS201 - U.S. History I
HIS202 - U.S. History II
MTH098 - Elementary Algebra (Full Term)
MTH098 - Elementary Algebra (Second Mini-Term)
MTH100 - Intermediate College Algebra (Full Term)
MTH100 - Intermediate College Algebra (Second Mini-Term)
MTH103 - Intro to Technical Math
MTH112 - Precalculus Algebra (Full Term)
MTH112 - Precalculus Algebra (Second Mini-Term)
MTH113 - Precalculus Trigonometry
MTH116 - Mathematical Applications (Full Term)
MTH116 - Mathematical Applications (Second Mini-Term)
MTH118 - Technical Math
MTH246 - Mathematics of Finance
MUS101 - Music Appreciation Call #27401
MUS101 - Music Appreciation Call #27402
MUS110 - Basic Musicianship
NUR200 - Fundamentals of Nursing
ORI101 - Orientation to College
PED123 - Golf: Beginning
PED124 - Golf: Intermediate
POL211 - American National Government
PSY107 - Study Skills
PSY200 - General Psychology - Dr. Stone
PSY200 - General Psychology - Mr. Nichols
PSY210 - Human Growth & Development - Dr. Stone
PSY210 - Human Growth & Development - Mrs. Siserir
SOC200 - Introduction to Sociology
SOC247 - Marriage & the Family
SPH107 - Fundamentals of Speech Communication

If your course is not listed above, please type the course title here:

*Semester:    *Year:

*I prefer to pick up my videotapes/DVDs(if applicable) at the:

*I prefer to take my onsite exams at:

*Is this your first distance education course at NW-SCC?
Yes       No

*You do plan on getting the Associate in Science - General Education Degree by taking only Distance Education courses.
Yes       No


*Items with a red asterick are required.