Fill out the form below in order to create a new account on this system. Once you've successfully registered, you'll be able to log in to the system immediately. Questions marked with a * are required.
Email Address *
First Name *
Last Name *
Standing (check all that apply) *
Age (check all that apply) *
School (check all that apply) *
Gender (check all that apply)
First or Home Language (check all that apply) *
2nd Language (N/A if English only)
Ethnicity (please choose one) (check all that apply)
American Indian/Alaska Native
Country of Origin (if Other, please specify) (check all that apply) *
I am a/an. . . (check all that apply) *
US Citizen or Permanent Resident
I choose to self-identify as a. . . (check all that apply)
1st Generation College Student
Armed Services Veteran
Student with a Disability
None of the Above
Passwords must be ten or more characters long.
Re-Enter Password *
Send me an email when my appointments are made, modified or canceled:
Send me an email with center announcements or other mass mailings:
Send me an email to remind me of my upcoming appointments:
Include iCal links with appointment confirmation messages? NoYes
Text Messaging Preferences
You have the option of receiving appointment reminders and waiting list "appointment available" notices via text message instead of via email.
In order to enable text messaging, enter your ten-digit mobile phone number and select your carrier below. Once saved, you can test text messaging by returning here and selecting the new "test" link below.
Depending on your mobile carrier and plan, you may incur charges for receiving text messages. By entering your number below, you agreee to be responsible for those charges. In order to opt out of receiving future texts, simply remove your number and carrier below.
Mobile Carrier:-- please select --AT&TCingular (GSM)Cingular (TDMA)CricketGoogle FiMetro PCSNextelSpectrum MobileSprint PCST-MobileUS CellularVerizon WirelessVirgin Mobile USXfinity MobileBell MobilityBellFido (Microcell)Koodo MobileManitoba Telecom SystemsNBTelPageNetRogersSasktelTelusVirgin Mobile Canada3 River WirelessAdvantage CommunicationsAirVoiceAllTelBell South (Blackberry)Bell South MobilityBell SouthBluegrass CellularBoost MobileCallPlusCarolina Mobile CommunicationsCellular One East CoastCellular One PCSCellular One South WestCellular One WestCellular OneCellular SouthCentral Vermont CommunicationsCenturyTelCingular WirelessCook PagingCorr Wireless CommunicationsDobson Communications CorporationDobson-Alex Wireless / Dobson-Cellular OneEdge WirelessGalaxy CorporationGrayLink / Porta-PhoneGTEHouston CellularInland Cellular TelephoneJSM Tele-PageLauttamus CommunicationMCI PhoneMCIMetrocall 2-wayMetrocallMidwest WirelessMobilecom PAMobilfoneMorris WirelessNextelNPI WirelessNtelosOmnipointOnlineBeepPacific BellPageMartPageOne NorthWestPCS OnePioneer / Enid CellularPrice CommunicationsProPagePublic Service CellularQwestRAM PageSafaricomSatelindo GSMSimple FreedomSmart TelecomSouthern LINCSouthwestern BellSprint PagingSunComSurewest CommunicationsTeletouchTelusTIMTritonTSR WirelessUnicelUSA MobilityVerizon PCSVirgin MobileWest Central WirelessWestern WirelessWyndtell
Fake Registration Prevention
In order to help prevent fake or automated registrations on this system, please complete the captcha form below.
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