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 *

Year Month Day

Highest Level of Education *

Some High School High School Graduate Some College/University Undergraduate Degree Some Graduate Studies

Have you taken a course with Prairie College Online or Prairie Distance Education before? *

Yes No

Are you providing us with a new address?

Yes No

Have you changed your name?

Yes No

If yes, previous name

Are you a current Prairie campus student? *

Yes No