Fillable Application for General Admission (Metropolitan Community College)

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Application for General Admission (Metropolitan Community College)

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Application for General Admission
Rev. July 2018
• U.S. citizens and permanent residents may apply online at www.mcckc.edu/apply. There is no application fee.
• International applicants (in the U.S. on a VISA, non-immigrants, undocumented or DACA) can find additional information,
including fees, at www.mcckc.edu/international
.
• If you have taken a credit class at Metropolitan Community College (MCC) anytime during the last year (after completing high
school), you don’t need to reapply, even if you skipped a semester.
• Students who took MCC classes while in high school should reapply as first time attending since high school.
PERSONAL INFORMATION
It is the policy of MCC to provide equal opportunity for all enrollment students and applicants for admission to the college, free from
discrimination based on age, race, color, religion, sex, sexual orientation, national origin, and/or disability, and harassment including
sexual harassment. The information you provide is kept confidential and is not used to determine acceptance for admission. Inquiries
concerning compliance should be addressed to MCC's Title IX coordinators.
First Name ________________________ Middle Name __________________ Last Name _________________________
Preferred First Name ________________________ Previous Last Name _________________________
Gender
Male Female Prefer Not to Answer
Date of Birth (mm/dd/yyyy) Social Security Number (SSN)
Although providing your Social Security Number is voluntary, it is required for financial aid and/or veteran education benefits and MCC
needs it in order to furnish Form 1098T, used when filing income taxes with the IRS. Providing your SSN also expedites matching to
existing records during application review and processing.
Are you Hispanic or Latino?
Yes No
Race
American Indian/Alaska Native Asian Black/African American
Native Hawaiian/Other Pacific Islander White
Citizenship/Immigration Status
U.S. Citizen Naturalized Permanent Resident
Refugee/Asylum DACA/Undocumented VISA Type ___________
Primary Language
English
Other __________________________
Country of Citizenship _____________________Country of Birth __________________City of Birth__________________
Military Status
No Service Retired Veteran Active
Spouse/Dependent of Active Missouri Member
Do either of your parents have a
bachelor’s degree?
Yes No
Are you interested in
financial aid or scholarships?
Yes No
CONTACT INFORMATION
Home Address _____________________________________________________________________________________
City ____________________________________ State __________ Zip/Postal Code _______________
Only if home state is Missouri, provide the following:
County ________________________________ Public K-12 School District ________________________________
Review your property tax statement or contact your realtor, landlord or County Assessor to determine the public school district for
your home address.
Rev. July 2018 Page 2
Mailing Address (only if different from home) ______________________________________________________________
City ____________________________________ State __________ Zip/Postal Code _______________
Cell Phone
(_____) _________________
Home Phone
(_____) _________________
Work Phone
(_____) ___________________
Preferred Phone
Email Address _________________________________________@___________________________
Once admitted, you will be assigned a student email account that we will use for most official school correspondence.
Emergency Contact
Name ______________________________ Phone (_____) _________________ Relationship ___________________
RESIDENCY STATUS
Residency status will determine the tuition rate you are charged for your classes. In accordance with Missouri law, many factors are
considered when determining residency such as citizenship status, military status, the public school district to which taxes are paid,
length of time at present domicile, purpose for living in Missouri, and your intent to make Missouri your permanent home. In most
cases, you must have been at your in-district or in-state residence for the past 12 consecutive months to receive that residency
status. For more information visit www.mcckc.edu/tuition
.
If you are under 21 years old and not legally emancipated, answer the questions as they pertain to your parent or legal
guardian. All questions in the section must be answered.
Answer the following if you provided a Missouri home address.
1. Have you (or your parent/legal guardian) lived in Missouri for the past 12 consecutive months?
Yes No If yes,
a. Have you/they lived in any combination of these districts (Belton, Blue Springs, Center, Fort Osage,
Grandview, Hickman Mills, Kansas City, Independence, Lee’s Summit, North Kansas City, Park Hill,
Raytown) for the past 12 consecutive months? Yes No
2. Are you (or your parent/legal guardian) living in Missouri for the purpose of retirement, full-time employment,
professional practice or to conduct a business AND intend to make Missouri your permanent home?
Yes No
OR
Answer the following if you did not provide a Missouri home address.
1. Did you (or your parent/legal guardian) pay Missouri income tax last year?
Yes No
2. Did you (or your parent/legal guardian) live in the state of Missouri during the last year?
Yes No If yes,
a. What is the approximate date you/they moved out of Missouri? _____________________
b. Did you/they live in Missouri for at least 12 consecutive months before moving?
Yes No
c. Before moving out of Missouri, did you/they live in any combination of these districts (Belton, Blue
Springs, Center, Fort Osage, Grandview, Hickman Mills, Kansas City, Independence, Lee’s Summit, North
Kansas City, Park Hill, Raytown) for 12 consecutive months?
Yes No
Rev. July 2018 Page 3
EDUCATION HISTORY
Request an official transcript from each school be sent to Metropolitan Community College, Student Data Center, 3200 Broadway,
Kansas City, MO 64111.
When classes start, what will best describe your high school experience?
Left high school without graduating or never attended high school
Completion Date _____________________
Working on/completed GED or Working on/completed HiSET
Attending/graduated from a Missouri high school
School Name ___________________________________________ City____________________________________
Attending/graduated from home school
Attending/graduated from a high school in a state other than Missouri
Graduated from a foreign high school
Indicate all other colleges attended (including high school dual credit).
School Name
City/State or Country
Dates Attended
Degree Earned
Date Completed
ENROLLMENT INFORMATION
When do you plan to start classes?
Fall Spring Summer 20 _____
Fall: August-December
Spring: January-May
Summer: June-July
Do you expect to take all your classes online?
Yes No
At which campus are you most likely to seek services in-person or attend activities?
Blue River Business and Technology Longview Maple Woods Penn Valley
At the time you start classes, which will best describe you?
Will still be in high school/home school while earning MCC credit
First time attending college since high school
Completed a bachelor’s degree or higher
Visiting from another college (typically just for one term)
Transferring (last school attended is a college other than MCC)
Returning after a year or more and have not attended any other colleges
Academic Interest _________________________________
Examples: Art, Criminology, Social Work
Anticipated Major _________________________________
Examples: Computer Science, Construction Management
Primary Goal at MCC
Earn a degree Earn a certificate Take classes and then transfer Personal enrichment
Take classes for job skills I do not know yet
If you select "Take classes and then transfer" or "I do not know yet" we will have you follow our Associate in Arts program. You can
always discuss this with an advisor once admitted.
Rev. July 2018 Page 4
STUDENTS WITH DISABILITIES
Metropolitan Community College (MCC) is committed to ensuring equitable access for all qualified students with disabilities
in accordance with the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. Each MCC campus
has a Disability Support Services (DSS) office that engages in an interactive process with students to determine reasonable
accommodations. Students who are requesting accommodations must self-identify and initiate the process by contacting
the campus DSS Coordinator.
MCC-Blue River: 816.604.6568
MCC-Business & Technology: 816.604.5491
MCC-Longview: 816.604.2254
MCC-Maple Woods: 816.604.3192
MCC-Penn Valley: 816.604.4293
More information is available at www.mcckc.edu/disability
.
CERTIFICATION
I hereby certify that to the best of my knowledge the information in this application is true.
• Upon admission, I agree to abide by the Student Code of Conduct
and all other rules and regulations of
Metropolitan Community College.
• I understand that deliberate falsification and/or omission of information pertaining to this application may result in
immediate dismissal and full loss of credits.
• I understand that my tuition rate
will be based on the information I have given in the residency status portion of
this application.
• If I am visiting from another college, I accept responsibility for verifying whether courses will transfer and/or apply
to my degree.
Applicant Signature ________________________________________ Date _____________________
U.S. Citizens and Permanent Residents:
RETURN COMPLETED APPLICATION TO
Metropolitan Community College
Student Data Center
3200 Broadway
Kansas City, MO 64111
International Applicants:
RETURN COMPLETED APPLICATION TO
Metropolitan Community College
International Student Services
3201 Southwest Trafficway
Kansas City, MO 64111
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Application for General Admission (Metropolitan Community College)

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Completed 23 July 2020

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