College Prep - Mindquest Registration Form

To register for the College Prep course from Mindquest, complete this form and submit. All fields must be completed.

Note:  There are no costs or fees for Mindquest courses.

Last Name: *
Last Name
First Name: *
First Name
Street Address: *
Street Address
City: *
State: *
Zip Code: *
Zip Code
Home Phone: *
Phone Number (xxxxxxxxxx)
Email: *
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Minnesota Resident:
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If yes, how long?
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Course: *
Course 1
*By entering my name, I am agreeing to all terms and stipulate that all information provided is correct.
We ask for your birthdate and last 4 digits of SSN to help ensure that we don't create duplicate accounts. * The following information will help Minnesota State Collegees and Universities evaluate student recruitment and retention policies. Providing this information is voluntary.
Name: *
Date: *
Date of Birth:
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Last 4 digits of SSN:
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Are you Hispanic or Latino?
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Racial Background:
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*Required field.