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Names
First Name
*
Please provide a First Name
Middle Name
Please provide a Middle Name (Optional)
Last Name
*
Please provide a Last Name
Birthday
Date of Birth (mm/dd/yyyy)
*
Address
Street Address
Please provide a Street Address
Contact
Phone
*
Please provide a Phone Number
Select One
Home
Cell
Business
Day
Evening
Email
*
Please provide an Email
Military
Military Status
*
Select One
None
Active Duty
Dept of Defense Civilian
Military Family Member
National Guard
Reserve
Veteran
Military Status
Account
Username
*
Please provide a User Name
Username Tips:
No spaces, punctuation, or symbols. Once created, the user name cannot be changed.
6-15 characters long
Must contain at least 1 number
Lower Case and UpperCase allowed
Password
*
Please provide a Password
Password Tips:
No spaces, punctuation, or symbols. The password is case sensitive
6-15 characters long
Must contain at least 1 number
Lower Case and UpperCase allowed
Password (confirm)
*
Please confirm your Password
Additional Information
I am interested in
*
Select One
Associates
Bachelors
Combined Bacc/Master
Grad Certificate
Masters
Other
I am interested in
I certify that I am the individual named on this application for a username and password and that I am applying for Web access for my personal use. In order to maintain the privacy of my academic records at Excelsior College, I agree that I will not disclose my username or password to any individual, company, organization, or business and that I will not grant any individual, company, organization, or business access to my personal account. I acknowledge that I have read, understand, and agree to abide by these Excelsior College policies:
*
Academic Honesty
Excelsior College Copyrights
Electronic Use
Student Rights and Responsibilities Policy
Privacy Rights
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Block User
Block Users:
You have been dismissed from Excelsior College for violation of academic policy. You are not eligible for student services at this time.
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