Request for Information

Please complete the form below to request more information about North Central State College and the programs we offer.

Contact Information

First Name

Do you have a Middle Initial or Name?

Middle Name

Last Name

Birth Date

Enter as MM/DD/YYYY

Mailing Address

Additional Address Information

City

State/Province

ZIP/Postal Code

Cell Phone

Please enter your phone number as ###-###-####. Example: 419-555-3535

Home Phone

Please enter your phone number as ###-###-####. Example: 419-555-3535

Email Address

Confirm Email Address

When do you plan to start taking classes?

Are you interested in earning a CERTIFICATE or two-year or four-year DEGREE from NC State?

My Academic Program of Interest

* - Programs indicated with an asterisk * can be completed entirely online.
Transfer - Programs indicated with Transfer are designed to be completed before transferring to another college or university to complete a 4-year degree.

Additional Comments or Requests