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NCSD Adult Ed Registration Form
Please take a moment to complete this form fully. If you have any questions, you may contact us at:
775-751-6822
Secretary - Mrs. Pam Fairchild:
pfairchild@nye.k12.nv.us
Clerical Aide - Mrs. Mary Hayes:
mhayes@nye.k12.nv.us
Counselor - Mr. Mike Abbiss:
mabbiss@nye.k12.nv.us
Teacher - Mrs. Bonnie Chenevert:
bchenevert@nye.k12.nv.us
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Last Name
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First Name
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Middle Name
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Maiden Name or Other Name Used in School - (This is important for when we request transcripts from other schools)
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Gender (Mark the gender with which you most closely identify)
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Street Address/Physical Address
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Apartment Number
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City
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Zip Code
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Phone Number
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Email Address
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Birth Date
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Birthplace (City, State)
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