UGotClass Secure Registration - Piedmont CC
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Registrant Information
*First Name:  
Middle Initial:  
*Last Name:  
*Address Line 1:  
Address Line 2:  
County (NC residents only)  
*Zip Code:  
*Home Phone:  
Work Phone:  
Cell Phone:  
*Date of Birth:  
Social Security Number  
Male Female 
Colleges and Universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and your own college/university communities, to describe the racial ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:
Do you consider yourself to be Hispanic/Latino?
Yes No 
Ethnic Origin:  
Educational Experience
*Highest Educational Level Completed
1 2 3 4 5 6 7 8 9 10 11 12 High School Graduate GED (General Educational Diploma) Vocational Diploma/Certificate Associate Degree Bachelor`s Degree Master`s Degree or higher 
Employment Status
*Employment Status:  
Electronic Signature
The information I have given is accurate to the best of my knowledge.
*Date    mm/dd/yyyy

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