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Create New Student Profile

Be sure to complete all the information possible. Click the "Submit" button at the bottom of the screen when you are done.

You must create a unique username. To ensure uniqueness,
we strongly recommend using your email address for your username.
* denotes required information.

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Username: minimum 6 characters
Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)
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 Privacy Policy
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Mail preference
May we include you on our mailing lists?
Yes No

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.
Cancel
Cancel

Primary Address
 
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Secondary Address

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Additional phone
 
 
Gender*
None Specified
Male
Female
Date of Birth*

(MM/DD/YYYY)
Are you fully vaccinated against COVID-19?*
Yes No
A vaccination requirement has been adopted by College of Marin (Board Policy 3507 – COVID-19 Vaccination Requirements). A No answer will not allow you to proceed.
Date of First Dose (mm/dd/yyyy)*
Date of Second Dose (mm/dd/yyyy)
Type of vaccine*

‘Click-Ctrl’ to select multiple options
Type your name as a signature.*

Your signature will attest that the information provided is true and correct.