Name
General Information
Date of Birth
MM/DD/YYYY format
Legal Sex
Female
Male
Other
Social Security Number
If you do not have a social security number enter all zeros.
Marital Status
Single
Married
Divorced
Widowed
Other
Do you intend to use Financial Aid?
Yes
No
Did you claim another individual as a dependent on your most recent taxes?
Yes
No
Ethnicity/Race
Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following question(s)
Select the option that best describes your ethnicity
Hispanic/Latino
Not Hispanic/Latino
Contact Information
Mailing Address
Enrollment Information
Have you ever enrolled at MCC?
This is my first time enrolling in any college for credit
I will be new to MCC with prior college credit
I will be a returning MCC student
Academic term & year you plan to enroll
Summer 2022-23
Spring 2022-23
Fall 2023-24
When do you plan on attending classes?
Morning
Afternoon
Evening
Weekends
Online
Degree Declaration
Pathway to Surgical Technology-PSGT- Assoc of Gen Studies Accounting, AAS Administration of Justice, AA Adult Education, Non-Degree Advanced Automotive Technology, Certificate Arizona Gen Edu Curriculum: Arts, Cert of Completion Arizona Gen Edu Curriculum: Business, Cert of Completion Arizona Gen Edu Curriculum: Science, Cert of Completion Art, AA Art, Visual Communication, AA Associate of General Studies Automotive Bodywork, Certificate Automotive Estimating, Certificate Automotive Refinishing, Certificate Baking, Certificate Basic Automotive Technology, Certificate Business & Entrepreneurship, AAS Business - Bookkeeping, Certificate Business - Retail Management, Certificate Business Administration, ABUS Business, Entrepreneurship & E-Marketing, Certificate CTE Entrepreneurship, AAS CTE Organizational Management, AAS Certified Caregiver, Non-Degree Chemistry, AS Computer Graphics & Web Design, AAS Computer Graphics & Web Design, Certificate Computer Information Systems Administration, AAS Computer Information Systems, ABUS Computer Science, AS Corrections Officer, Certificate Culinary Arts Management, AAS Culinary Arts, Certificate Cybersecurity & Network Support, AAS Cybersecurity & Network Support, Certificate Dental Assisting, Certificate Early Childhood Education, AA Education, AA Electrical Tech - Commercial/Industrial Elec, Certificate Electrical Technology - Residential Wiring, Certificate Engineering, AS English, AA Fire Science - Fire Fighter, Certificate Fire Science, AAS Food Management, Certificate Food Preparation, Certificate Geology, AS HVAC Installation, Certificate HVAC Residential, Certificate HVAC/R Light Commercial, Certificate Healthcare Information Technician, AAS High School Equivalency Diploma, Non-Deg History, AA Law Enforcement Academy Preparation, Certificate Liberal Arts, AA Life Science, AS Mathematics, AA Medical Assistant Medical Coding & Billing, Certificate Medical Assistant Phlebotomy, Certificate Medical Assistant, Certificate Non-Degree Seeking Nursing Assistant Program, Non-Degree Organizational Management, Certificate Paralegal, AAS Paralegal, Certificate Pathway to Dental Hygiene -PDAE- Liberal Arts Pathway to Nursing -PADN- Liberal Arts Pathway to Paramedic -PEMS- Associate of General Studies Pathway to Physical Therapy -PPTA- Liberal Arts Pathway to Radiologic Tech -PRADT- Associate of Gen Studies Pathway to Substance Abuse Counseling -Psac- Liberal Arts Professional Applications, Certificate Programming & Game Development, Certificate Science, AS Social & Behavioral Science, AA Social Studies, AA Welding Technology - Fillet Weld, Certificate Welding Technology - GMAW/FCAW Pipe, Certificate Welding Technology - GMAW/FCAW Plate, Certificate Welding Technology - GTAW Pipe, Certificate Welding Technology - GTAW Plate, Certificate Welding Technology - SMAW Pipe, Certificate Welding Technology - SMAW Plate, Certificate
If you are seeking to pursue multiple programs simultaneously or wish to change your program of study from what is selected here, you will need to meet with an academic advisor to complete a degree declaration form to add these programs to your student account.
If you are planning on applying for Financial Aid or Veteran Educational Benefits, the degree declaration is an important component of eligibility.
Have you previously attended any other college or university?
No
Yes
Do you have a GED?
No
Yes
Reason for Enrolling
Earn GED Earn an MCC Degree/Cert Other Personal Interest Prepare to enter job mark Transfer to College/Univ
Why did you choose MCC?
Affordable Tuition
Availability of Financial Aid and Scholarship Opportunities
Specific Field of Study
Quality of Education
Flexible Course Scheduling and Delivery
Location
Campus Experience
Extracurricular Activities
What will your employment status be while enrolled?
Not employed
Employed full time
Employed part time
What is your 1st Parent/Guardian's highest educational level?
Less than High School
GED
Vocational/Technical
Some College
Associates Degree
Bachelors Degree
Some Graduate School
Masters or Professional
Doctoral Degree
Unknown
What is your 2nd Parent/Guardian's highest educational level?
Less than High School
GED
Vocational/Technical
Some College
Associates Degree
Bachelors Degree
Some Graduate School
Masters or Professional
Doctoral Degree
Unknown
Will you be using VA benefits?
Yes
No
Veteran Type
Chapter 30
Chapter 31/VR&E
Chapter 32/VEAP
Chapter 33/Post 9/11
Chapter 35/Dependent
Chapter 1606/National Guard
Dependent/Active Military Duty
Department of Defense Employee
Tuition Assistance
Vet Assistance/Active Duty
VA Work Study
Are you currently serving in the military?
Yes
No
Military Status
Active
Active Reserve
Reserve
Branch
Air Force
Army
Coast Guard
Marines
National Guard
Navy
Space Force
Citizenship
Student must be prepared to provide evidence of citizenship, permanent residency or other lawful immigration status.
Are you a U.S. Citizen?
Yes
No
I am a Citizen of
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas (the) Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State) Bonaire, Sint Eustatius & Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands (the) Central African Republic (the) Chad Chile China Christmas Island Cocos (Keeling) Islands (the) Colombia Comoros (the) Congo (Democratic Republic) Congo (the) Cook Islands (the) Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic (the) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands [Malvinas] Faroe Islands (the) Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia (the) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (the) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique Mauritania Mauritius Mayotte Mexico Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (the) New Caledonia New Zealand Nicaragua Niger (the) Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (the) Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines (the) Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation (the) Rwanda Réunion Saint Barthélemy Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan (the) Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (the) Tuvalu U.S Minor Outlying Islands Uganda Ukraine United Arab Emirates (the) United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara* Yemen Zambia Zimbabwe Åland Islands
Do you have a Permanent Resident/Green card?
Yes
No
Do you hold a valid Non-Immigrant Visa?
Yes
No
Which type of Visa do you have?
B-1/B-2 Visa
F-1 Foreign students at an approved academic institution
F-2 Spouse or qualifying child of an F-1 nonimmigrant
H-1 Visa
H-4 Visa
J-1 Foreign nationals in exchange visitor program in the US
J-2 Spouse or qualifying child of an J-1 nonimmigrant
M-1 Foreign nationals at OISS-approved vocational school
M-2 Spouse or qualifying child of an M-1 nonimmigrant
Residency Status
To be considered an Arizona resident for tuition purposes, you must have resided in the state continuously for at least 12 months prior to submitting this admission application.
Do you reside in the state of Arizona?
Yes
No
I do not reside in the United States
What country do you reside in?
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas (the) Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State) Bonaire, Sint Eustatius & Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands (the) Central African Republic (the) Chad Chile China Christmas Island Cocos (Keeling) Islands (the) Colombia Comoros (the) Congo (Democratic Republic) Congo (the) Cook Islands (the) Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic (the) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands [Malvinas] Faroe Islands (the) Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia (the) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (the) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique Mauritania Mauritius Mayotte Mexico Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (the) New Caledonia New Zealand Nicaragua Niger (the) Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (the) Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines (the) Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation (the) Rwanda Réunion Saint Barthélemy Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan (the) Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (the) Tuvalu U.S Minor Outlying Islands Uganda Ukraine United Arab Emirates (the) United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara* Yemen Zambia Zimbabwe Åland Islands
Have you resided in Arizona continuously for the last 12 months?
Yes
No
What is/was your state of residence?
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Micronesia Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Armed Forces - Americas U.S. Armed Forces - Europe U.S. Armed Forces - Pacific United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming
While I have not been a resident of Arizona for 12 continuous months,
I live in Arizona with my parent(s) and they claim me as a dependent on their tax return.
I am employed as a full-time teacher or full-time non-certified classroom aide by an AZ school di
I or my spouse was required by an employer to transfer to Arizona.
I am a member and resident of a tribe whose reservation lies partially or wholly in Arizona.
I am, my spouse is, or I am a dependent of a current member of the Armed Forces of the US.
I am, or I am a dependent of an honorably discharged member of the Armed Forces of the US.
GED Information
GED Test Date
MM/DD/YYYY format
GED Testing Center State
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Micronesia Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Armed Forces - Americas U.S. Armed Forces - Europe U.S. Armed Forces - Pacific United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming
High School Information
Did you graduate or are currently a student in high school?
Yes
No
Student Support Documentation
In order to determine your appropriate tuition rate, MCC asks for you to upload a government-issued photo ID and Social Security Card. All students are initially defaulted to our Out-of-State tuition rate until documentation has been submitted and reviewed.
If you are unable to provide the necessary documents now, you will receive an email from Enrollment Services directing you to scan required documents into the MCC secure site. Required documents may include any of the following: Social Security card, Driver's License, Permanent Resident Card, Visa, Foreign Passport. All applicants are considered out-of-state students until Residency and Citizenship documents have been reviewed by Enrollment Services. Once documents have been reviewed, your tuition status will be determined.
For questions regarding acceptable documents, please email enrollmentservices@mohave.edu.
Acknowledgment
By submitting this form, I hereby certify that, to the best of my knowledge, the information furnished is true and complete without intention of evasion or misrepresentation. I understand the above information submitted is under penalty of perjury, and false or misrepresentative data is sufficient cause for rejection of this admission form.
By submitting this application, I agree to abide by the student rules and regulations of the institution regarding conduct and other obligations during my time with Mohave Community College.
I have read and understand the paragraph above (required)
Student Registration Agreement
I understand that:
MCC is advancing value to me in the form of educational services and my right to register is expressly conditioned upon my agreement to abide by the college academic and financial policies and to pay the cost of tuition, fees and any additional costs when those charges become due.
Regardless of my eligibility for financial aid, VA education benefits or any 3rd party promissory notes, I am personally responsible for the full amount assessed to me as a result of my registration and attendance.
Failure to pay tuition and fees will result in a hold on my record that prevents participation in registration and academic activities (attending classes, adding or withdrawing from classes, etc.)
If I am utilizing the third-party provider for payment plans, missing ANY scheduled payment results in immediately paying the entire balance due or I will be administratively withdrawn from all my classes.
Should my account become delinquent, MCC reserves the right to transfer my account to Arizona Department of Revenue (AZDOR), a contracted collection agency, attorney and/or credit bureau. I will be held responsible for collection costs, including any fees charged by AZDOR, the collection agency and attorney's fees in addition to my outstanding balance. I authorize MCC and its agents to utilize all contact information to collect any debt I owe to MCC, (including, but not limited to cell phone numbers and email addresses I have provided to the College, etc.)
MCC will apply any financial aid I receive, including grants, loans and scholarships to tuition and fee charges assessed to my account.
I must follow the formal add/drop and withdrawal procedures of MCC.
MCC will deliver my IRS Form 1098-T electronically every year I have reportable transactions. Students will receive notification when their 1098-T is available along with instructions on how to access the form.
Dropping or withdrawing from a class may impact my Financial Aid and generate charges I must pay due to funds being returned to federal and state financial aid programs and/or scholarship donors. My graduation date may also be impacted. I should discuss consequences with my advisor before dropping or withdrawing from a class.
Dropping, withdrawing from or being administratively withdrawn from my course(s) may impact my funding if I am receiving VA education benefits. I should discuss the impact with an advisor or the veteran services coordinator before making any changes.
I will be administratively dropped from class if I fail to attend (on-ground courses) or participate (online courses), or contact the instructor, during the first calendar week after the official start date, or within seven days of my registration if I register after the official start date.
I may be administratively withdrawn after three consecutive weeks of non-participation, following the first week of the class. This can affect my financial aid or VA education benefits.
Mohave Community College does not discriminate on the basis of race, color, ethnicity, national origin, gender, sex, age, religion, gender identity, gender expression, disability, or sexual orientation in its educational programs and activities or employment practices. For more information on discrimination issues or to file a complaint, I can contact my campus dean or visit
https://www.mohave.edu/about/safety/# . More information can be found regarding Title IX at
http://knowyourix.org/
I Agree (required)
What's Next?
Once your application has been processed your MCC ID number will be emailed to you along with a link to register for Student Orientation and the next steps needing to be taken in order to register for classes.
Submit Application
Title IX is a federal law that makes it illegal to discriminate against a person on the basis of sex in any federally funded activity.
Title IX Coordinator
Danette Bristle
dbristle@mohave.edu
TitleIX@mohave.edu
Wk: 928.704.9480
Cell: 928.542.6920