omplete this admission form and send it to Moraine Valley Community College, Admissions Office, 9000 W. College
Pkwy., Palos Hills, IL 60465-2478, or email to admissions@morainevalley.edu. You also may complete this form at the
Office of Multicultural Student Affairs, Building S, Room S216, (708) 974-5475.
You are eligible to enroll at Moraine Valley Community College if you are:
1. A graduate from an accredited high school
2. A recipient of a high school equivalency certicate
3. At least 18 years old and capable of beneting from college-level instruction. High school students must be at least 16 years old
at the time of registration and submit a completed high school authorization form.
4. Planning to enroll in English as a Second Language, high school equivalency or Adult Basic Education classes
Please enter your full legal name (no nicknames).
First Name _______________________________ Middle Initial ____ Last Name ___________________________ Sux _____
Birth Date ______ / ________ / _________________
Home Address _______________________________________________________________ Apt or Unit # _____________
City _______________________________________ State ____________________________ ZIP code _______________
Email Address _____________________________________________________________
Primary Phone Number ______________________________
Secondary Phone Number ___________________________
Alternate Phone Number _____________________________
Cell Home Business
Cell H
ome Business
Cell Home Business
Gender oMale oFemale
Is English your primary language?
oYes oNo
If not, please indicate your primary language
Are you of Hispanic or Latino orgin?
oYes oNo
Please identify your primary racial/ethnic group
oAmerican/Alaska Native oAsian oBlack or African American
oHawaiian/Pacic Islander oHispanic or Latino oWhite oOther ________________________________________________________
Have you ever served in the military?
oYes oNo
High School Information
Where did you last attend high school?
High School Name
City _____________________________________________________ State ________
oForeign high school graduate oHome schooled oNone
Completion Status
oGraduated oWithdrawn from High School oHigh School Equivalency oOther Equivalency oCurrently Attending High School
______ / _______ / _______ What is your degree/certicate objective?
MONTH DAY YEAR oTo complete 1+ courses oCerticate oAssociate Degree
What is your current reason for attending?
oTransfer to a Four-Year Institution oJob Skill Improvement oNew Job Skills After MVCC
oBasic Academic Skills/High School Equivalency/ESL oPersonal Interest/Self Development oOther
Do you plan to transfer to a four-year college or university?
oI plan to transfer oNot planning to transfer
Admission Application
Admissions Aid Oce: Building S, Room S101
Highest degree previously earned?
oGED oHigh School Diploma oSome College/University oCerticate oAssociates Degree oBachelor’s Degree
oMasters Degree oFirst Professional Degree oDoctoral Degree oOther oNone oUnknown
Associate in Arts (A.A.), Associate in Science (A.S.), and Associate in Fine Arts (A.F.A.) for students whose goal is to
transfer to a four-year college or university for a bachelor’s degree.
Associate in Applied Science (A.A.S.) degree programs and certicate programs are for students whose goal is
immediate employment upon graduation from Moraine Valley.
Choose program of study (from the degree and certicate programs list starting on next page)
Program Name ________________________________________________________________________________________________________
Program Code ______________________________________________
Colleges Attended
______________________________________________________ City ________________________________________ State ________
Name ______________________________________________________ City ________________________________________ State ________
Name ______________________________________________________ City ________________________________________ State ________
Parent Information
Highest level of education completed by your mother
oGrade school or less oSome high school oHigh school grad or GED oSome college oAssociate degree oBachelor’s or higher
Highest level of education completed by your father
oGrade school or less oSome high school oHigh school grad or GED oSome college oAssociate degree oBachelor’s or higher
Education Status
oCurrently attending a university Name of school __________________________________________________________________________
Do you plan to attend part-time or full-time? oFull Time oPart Time
Do you plan to apply for nancial aid? oYes oNo
Desired Start Term
oFall oSpring oSummer Year _______
How did you learn about Moraine Valley Community College?
oNewspaper oBillboard oSocial Media oFriend/Family oCollege guide oMVCC website oCollege recruiter/event
oReferral oPublic event oRadio oHigh school counselor oMailer oAlumni oTV
Condential when completed.
I certify that I have read and understand all items on this form and all information provided for my nancial aid is true and correct.
Student’s Signature __________________________________________________________ Date _________________________