Create New Student Profile

Profile must be created for the person attending the class

Profile Creation tips:

Use your (or student) legal name.
To receive class confirmations details and receipts, include a valid email.
To receive text communications, opt in on tab two.
Add your (or student) address, any official documents will be sent to the one provided.
Profiles cannot be shared amongst others in a company, household, etc. Each student must have their own profile, changing the profile to another student name is prohibited
Learners under the age of 18 are not permitted to enroll in non-youth courses unless otherwise specified in the class description.

Required indicates required information. * denotes required information.

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Username Required*

Username: minimum 6 characters

Privacy Policy

Privacy Policy
Kirkwood recognizes the importance of and is committed to protecting the privacy rights of our students, employees, and community business partners. Information collected will be used for College purposes only.

Personally Identifiable Information (PII)
Kirkwood will only collect PII which you knowingly and voluntarily provide. If you provide us with PII, we may use this information to contact you in regards to your implied interest in the College. Transmission of PII is secured with SSL encryption to ensure the privacy of this sensitive information. The PII we do collect is stored in databases and files that are protected and secured via industry accepted best practices

At no time do we disclose PII except under the following conditions:

We have your consent to share the information
We need to share your information in order to provide the service or product you requested
When required to do so by subpoenas, court orders, or any other legal process
Kirkwood State Reports required by the Department of Education

Password Required*

Password: minimum 12 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)

Password Strength

Re-enter password Required*

Password hint Required*

Identity Verification Question Required*

Identity Verification Answer Required*

E-mail Required*

Re-enter E-mail Required*

Preferred First Name

First name Required*

Middle Name

Last name Required*

Former Last Name

Birthdate

mm/dd/yyyy

Social Security Number

Some professional licensures require SSN example (999999999) do not add only partial SS numbers.

Gender

Male
Female
Non-binary
Identity not listed
Prefer not to disclose

Race

Cancel

Primary Address

Primary Address Type Required*

Country Required*

line 1 > AddressRequired*

line 2 > Address

City Required*

State Required*

Province Required*

Zip Required*

Zip+4

Secondary Address

Same as Primary Address

Secondary Address Type

Country

line 1 > Address

line 2 > Address

City

State

Province

Zip

Zip+4

Phone Required*

Phone 1 Type

Phone 1 Number

Phone 1 Extension

Additional phone

Phone 2 Type

Phone 2 Number

Phone 2 Extension

Phone 3 Type

Phone 3 Number

Phone 3 Extension

Phone 4 Type

Phone 4 Number

Phone 4 Extension

Receive text communications? Required*

Yes No

Text communications number Required*

Receive text notifications for

Use Ctrl key with mouse click to select or unselect multiple options

Mail preference

May we include you on our mailing lists?

Yes No

E-mail Preference

Yes No
Receive promotions via email

Cancel

Company

If your company is not available in the list, select ** Add Company ** and you will be prompted to add your company's information after submitting this form.

Employer

Company Type

Educational Level

Type 1-Professional License Type

Type 1-Professional License Number

Professional license number for state recertification

Type 1-Professional License Number Expiration Date

mm/dd/yyyy

State that Professional License has been issued

NREMT Registration Number

Applicable to people who are currently certified by the National Registry of Emergency Medical Tech

NREMT Re-Registration Date

mm/dd/yyyy

Type 2-Professional License Type

Type 2-Professional License Number

Professional license number for state recertification

Type 2-Professional License Number Expiration Date

mm/dd/yyyy

Cancel

Profile Information Changed

Changes to your profile information in this web site have not been submitted to Colleague.

Please contact the HR department to ensure your official records are updated.

Name Changed

Would you like your name changed on all your class records?

Please click on 'All Records' to update your name on all records and 'Profile Only' to update only your student profile.

Profile Information Changed

Would you like your profile information changed on your class records?

Please click on 'All Records' to update your profile information on all class records and 'Profile Only' to update only your student profile.

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Create New Student Profile

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