Student Type: New Student to MCCC Transfer Student Guest Student International Student Dual Enrollment

*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: Choose One Fall Winter Spring Summer

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

Educational Goal: Undecided Associate Degree Certificate Non-degree

Resident Status: Choose One Resident of Monroe County Resident of Michigan/not Monroe County Resident of state other than Michigan Resident Alien Non-Resident Alien International Student

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? Please choose one Yes No

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.