NCGLEA Registration
Use this form to register. Please fill in the required field
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If you prefer to use the old method to register, please
Click Here
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Course Name:
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Course Start Date::
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Agency::
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Agency Address::
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Student Name::
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Student SSN::
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Student Email::
2nd Student Name::
2nd Student SSN::
2nd Student Email::
3rd Student Name::
3rd Student SSN::
3rd Student Email::
4th Student Name::
4th Student SSN::
4th Student Email::
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Authorizing Official::
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Authorizing Officials Email:
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Tel. Number:
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Enter Captcha Code: