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Section 1 of 2
NCUS-TEC Application
Life Works When You Work
First Name
*
Last Name
*
Upload State ID
Last four of your Social Security Number:
*
Gender
*
Male
Female
Non-Binary
Birth Date
*
Age
*
Email Address
*
Please select todays date
*
+
Ethnicity
*
American Indian/ Alaskan Native
Asian/ Pacific Islander
Black/ African American (Non-Hispanic)
Hispanic
Multiracial
White (Non-Hispanic)