MCC Office Use Only
Student MCC ID#:
Eval Program
XDNS - English
Yes
No
Last Term Attended
XDNS Math
Yes
No
MCC GPA
XDNS Reading
Yes
No
MCC Probation/Warning
P
HS IASU
HS-GPA
Progress
Yes
No
Career and College Promise Enrollment Form
This form must be completed for each student for each enrollment period. The student must be making appropriate progress
toward high school graduation. A full description of enrollment requirements for College Transfer & Career Technical
Education pathways is available in the MCC Catalog. Assessment scores must be provided to determine eligibility. To maintain
eligibility for enrollment, students must maintain a 2.0 college grade point average after completion of two college courses.
First Name
Middle Name
Last Name
Semester/Year
Grade
Address
City/Town, State Postal Code
Telephone No.
Date of Birth
Social Security No.
Institution Name
Curriculum Course to be Taken at Martin Community College
Couse Prefix
Course Number
Section
Course Title
Credit Hours
Signature of School Principal or Designee
Signature of MCC Counselor/Transition Advisor
In accordance with the Family Educational Rights and Privacy Act of 1974, I hereby grant permission to
release all relevant academic records to my school of origin. I understand that college policies are
available in the Martin Community College Career Catalog at www.martincc.edu.
Signature of Student
Date
Check the Appropriate Program
College Transfer Pathway
Associate in Arts
P1012C
Associate in Science
P1042C
Career Technical Education Pathways
Air Cond., Htg. & Refrig. – Heat Pump Cert.
C35100P1
Air Cond., Htg. & Refrig. – Refrig. Cert.
C35100P2
Automotive
D60160P
Business Administration Dipl.
D25120P
Cosmetology
D55140P
Early Childhood Education Dipl.
D55220P
Equine Training Technology Dipl.
D15190P
Industrial Systems Tech. Dipl.
D50240P
Industrial Systems Weld. Tech. Cert.
C50240P1
Industrial Systems Facility Maint. Cert
C50240P2
Information Technology Foundations Cert.
C25590P1
Information Technology Windows/OS Security
C25590P2
Medical Assisting Cert.
C45400P
Medical Office Administration Cert.
C25310P
Assessment Scores
Assessment Name
Date
Subject
Score
English
Reading
Math
College Transfer Pathway Only
High School
Cumulative
GPA
Provisional Status Students must first complete a college-level
English (ENG) and mathematics (MAT) course with a grade of ‘Cor
better to be eligible to register for other courses in a college
transfer pathway. Eligible students must satisfy the following
criteria:
Cumulative Weighted 3.5 GPA or Higher and;
Completed 2 years of HS English with “Cor higher and;
Completed HS Algebra II, MAT III (or higher) with “Cor better
MCC Counselor: Complete Prerequisite Override
MARTIN
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