Online Course Registration

Online Course Registration
First Name*
Middle Name
Last Name*
Preferred Name
Phone Number*
Email*
Mailing Address*
City*
Province/State*
Postal/Zip Code*
Country*
Birth Date*

YearMonthDay
Highest Level of Education*

Some High SchoolHigh School GraduateSome College/UniversityUndergraduate DegreeSome Graduate Studies
Have you taken a course with Prairie College Online or Prairie Distance Education before?*

YesNo
Are you providing us with a new address?

YesNo
Have you changed your name?

YesNo
If yes, previous name
Are you a current Prairie campus student?*

YesNo