Application for Admission

Please complete information below:

 * - Indicates a required field

PLEASE NOTE: If you are a RETURNING student, you do not need to fill out our application again. However, if you have a name change or address change, please contact the Registrar's Office to change your information at 734-384-4108.

Student Type:

*Last Name:  *First Name:  Middle Initial:

Former Name:

*Permanent Address: *City: *State: *Zip:

County:

*Home Phone Number:

*Social Security Number:        *Date of Birth: (MM/DD/YYYY)
*If you are applying for Financial Aid, it is important to provide your correct number, both here and on your Financial Aid Application.

Which best describes you? (Check all that apply)

White, Non-Hispanic     Black, Non-Hispanic     Hispanic/Latino      Asian American

American Indian/Alaska Native      Native Hawaiian/Pacific Islander    Non-Resident Alien

*Required: Please check one   Male     Female

Veteran      Spouse of a Veteran

Please choose the semester you plan to begin at MCCC.

*Semester you plan to attend:

Program of Study: (to see list in separate browser window, click here)

Educational Goal:

Resident Status:

Contact person in case of emergency. Name: Phone:

High School Information

High school from which you graduated (or will graduate):

*High School:

City: County: State:

*Date of Graduation (actual or planned - month/year):

GED Graduate (date of completion - month/year):

Please send high school transcripts or GED scores to the Office of Admissions.

Transfer Information

If you have attended another college or university, complete the information below.
Have all official college transcripts sent directly to the Registrar's Office.

*REQUIRED* Have you ever attended another college?

College NameCityState

The following information is optional and will be used to further define the diversity of our institution.
Your response will not affect the consideration of your application.

 Learned about MCCC through: Newspaper  TV  Radio  Internet  Direct Mailer  Family/Friend
  MCCC Web Site MCCC Student/Staff H.S. Counselor Other College/University
Current employment status: Full-Time Part-Time (15+ hrs/wk) Part-Time (-15 hrs/wk) Unemployed (Seeking Work)
  Unemployed (Not Seeking Work) Homemaker/Retired
Highest level of education attained by your...

Mother:  

Some High School H.S. Graduate GED Some College Associate Degree
  Bachelor Degree Other

Father:  

Some High School H.S. Graduate GED Some College Associate Degree
  Bachelor Degree Other
Estimated Household Income: $10,000 or less             $10,000 to $20,000      $20,000 to $30,000
  $30,000 to $40,000       $40,000 to $50,000      $50,000 or more
Marital Status: Single   Married   Divorced   Widowed/Widower
Number of People in Household:          Number of My Dependents (under the age of 18):
Email Address:
Is English your first language? Yes
  No (please list your native language) 

APPLICATION MUST BE SIGNED BEFORE BEING CONSIDERED FOR ADMISSION.• I certify that the information provided on this application is complete and accurate in every respect. • I understand that falsification or omission of any information requested on this application may result in cancellation of admission or registration. • If admitted, I agree to observe all rules and regulations of Monroe County Community College as printed in the College Catalog and Student Handbook.• By signing this application, I am granting permission to MCCC, its agents and staff to use video and photographs of myself for MCCC promotional /advertising materials without charge. No promises have been made, no consideration is involved for their use. If I do not want MCCC to use video and photographs of myself, I will inform the Director of Admissions and Guidance Services.

*Applicant's Name: *Today's Date: (MM/DD/YYYY)

Monroe County Community College is an equal opportunity institution and adheres to a policy that no qualified person shall be discriminated against because of race, color, religion, national origin or ancestry, age, sex, marital status, or disability in any program or activity for which it is responsible.