NMT Non-Degree Student Application

I am applying for:

Year 20

Have you taken classes at New Mexico Tech?

Do you have a bachelor's degree?

Student Name

First NameLast Name

Student ID # or SSN

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

NMT Email Address:

example@example.com

Non-NMT Email address:

example@example.com

Are you a New Mexico Resident?

Date of Birth

Date

Address

Mailing Address

Street Address Line 2

CityState

Zip Code

Have you ever been convicted of a crime that could have resulted in one year or more of prison time (following a jury or bench trial, a guilty plea, or a nolo contendere pleas), been charged with such a criminal offense that was later dismissed as a result of a plea bargain or alternative sentencing arrangement, or are such criminal charges pending or expected to be brought against you? You are under continuing obligation to immediately update your response to this question if your circumstances change after you submit this application.

If yes to previous question, for each crime you must provide a detailed explanation and copies of all official records related to your case. Include state, location, crime, dates, and case number. If applicable, provide the name and phone number of your parole or probation officer. Finally, by submitting your readmission application, you are giving NMT’s representatives authority to investigate your record and giving legal authorities permission to discuss your case with NMT’s representatives.

If needing to provide documents to above question, attach here:

Have you attended another College or University?

Are you planning to take courses other than Community Education or Physical Recreation?

Did you leave on academic suspension or probation?

(If yes then you are limited to non-academic courses; ASAC readmission is required for academic courses)

I certify that all information given in this application is complete and accurate. If I am accepted as a student at New Mexico Institute of Mining and Technology (New Mexico Tech), I agree to conform and abide by all rules, regulations, and procedures of the Institute. Misrepresentation in any statement by me will be considered adequate grounds for denial of admission, for cancellation of registration, or dismissal from the Institute.

Signature

Date

*This applies only to non-degree-seeking, non-credit, and special case students.

NEW MEXICO TECH – Community Registration Form

Rows	CRN	Subject	Course Number	Section	Credit Hrs	Course Title	Days	Time

Total hours you would like to take:

Signature required to complete registration.

Signature