Mt. San Jacinto College

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*First Name:

*Last Name:

*MSJC Student Email Address:
Student Email ends with @student.msjc.edu

*Alternate Email Address (needed to notify you of your new temporary password after reset):

*7-digit MSJC Student ID#:

*6-digit Date of Birth:

*Last 4 digits of Social Security Number:

*Phone Number:

*Campus:

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