MCC Admissions Application

If you need assistance with this form, please contact MCC Connect at 866-664-2832.

All yellow fields are required

Name

Please use your full and legal first and last names

(Legal) First Name

Preferred First Name (if different)

(Legal) Full Middle Name

(Legal) Last Name

Suffix Jr., Sr., etc.

Other last name(s) used

General Information

Date of Birth

MM/DD/YYYY format

Legal Sex

Social Security Number

If you do not have a social security number enter all zeros.

Marital Status

Did you claim another individual as a dependent on your most recent taxes?

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

In addition, select one or more of the following racial categories to describe yourself

American Indian or Alaska Native
Asian
Black or African
Native Hawaiian or Other Pacific Islander
White

Contact Information

E-Mail Address

IMPORTANT: Enter your e-mail address to receive important information about Mohave Community College. Once enrolled this will authorize MCC to send information such as registration information, academic performance, financial aid, disbursement eligibility, billing statements, charges, and past due amounts to this e-mail account.

Cell Phone Number

Please be sure to include area code

Home Phone

(At least one phone number is required)
Please be sure to include area code

Full name of person to contact in case of an emergency (cannot be student)

Emergency Contact Phone Number

Please be sure to include area code

Mailing Address

Address Line 1

Address Line 2

City

State

Zip

Country

I live outside the United States

Do you live at your mailing address

Permanent Address

Address Line 1

Address Line 2

City

State

Zip

Country

Enrollment Information

Have you ever enrolled at MCC?

Academic term & year you plan to enroll

When do you plan on attending classes?

Degree Declaration

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?

Do you have a GED?

Reason for Enrolling

Why did you choose MCC?

What will your employment status be while enrolled?

Have either of your parents completed a four-year college degree?

Citizenship

Student must be prepared to provide evidence of citizenship, permanent residency or other lawful immigration status.

Are you a U.S. Citizen?

I am a Citizen of

Do you have a Permanent Resident/Green card?

Do you hold a valid Non-Immigrant Visa?

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?

What country do you reside in?

What is/was your state of residence?

GED Information

GED Test Date

MM/DD/YYYY format

GED Testing Center State

High School Information

Did you graduate or are currently a student in high school?

High School Graduation Date Actual or Anticipated Date

MM/DD/YYYY format

Name of high school

High School City

High School State

College Information

Name of Last College/University Attended

Enter Full Name of College/University (Do not use initials such as ASU, NAU)

Is the College/University in the United States?

College/University City

College/University State

Did you graduate from this institution? If so, please provide the date

List any other previous college(s) attended

*NOTE*
In order to have previously earned credit evaluated for transfer or to be eligible to receive financial aid, official transcripts must be requested from each institution. Have these transcripts sent directly to: Transcript Evaluation Department, Office of the Registrar, Mohave Community College, 1971 Jagerson Avenue, Kingman, AZ 86409.

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)

What's Next?

Once your application has been processed your MCC ID number will be emailed to you.

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.

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