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Create a Student Account

Please fill out the following to create a student account. All contact information provided below can be updated at a later date by logging in and going to your profile information.

Important: If you have already been through the interview process for MECOP at least once, you do not need to fill out this form (you already have an account). To login, please use the email you provided during the application process.

Basic Information

First Name

Middle Name

Last Name

Preferred Pronouns (optional)

This will be used on some pages that display your name. If you would prefer that gender pronouns not be displayed on your account, leave this field blank and it will automatically be omitted.

Primary Email

This address will be used for all program related communications as well as your primary email for logging in and account recovery.

Backup Email

This address will only be used for account recovery, and as an alternative login email in the event you lose access to your primary email account.

Phone Number

This will only be used for program related correspondence.

Physical Address

Please specify your permanent mailing address. This address will be used if we need to mail you any important information.

Address

City

State

Zip

Emergency Contact

Name

Phone Number

Address

Background Information

Notice: Providing the following information is optional and based on your self-identification. If you choose to participate, please answer both questions by checking the appropriate box or boxes. MECOP, Inc. may use this data to compile internal reports, and aggregate data and analysis may be shared with MECOP, Inc. Members. All reports generated will be anonymous and strictly used for statistical analysis. The ethnicity and race data you choose to provide will be used only in accordance with applicable laws, executive orders, and government regulations. In accordance with its policies, MECOP, Inc. does not discriminate or permit harassment on the basis of race, color, national origin, gender, or any other legally protected status.

Gender

Male

Female

Not Specified

Are you Hispanic or Latino?

Yes

Not Specified

Please select the racial category or categories with which you most closely identify by selecting the appropriate box (leave blank if you do not want to respond).

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Set a Password

Passwords must be at least 8 characters long and contain numbers, upper case letters, and lower case letters.

Password

Confirm Password

Cancel