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:

*Cell Phone Number: Alternate Phone Number:

*Email Address:

*Date of Birth: (MM/DD/YYYY)

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 Name	City	State

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.