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
Cooperative Innovative High School Enrollment Form
This form must be completed for each Cooperative Innovative High School (CIHS) student for each enrollment period. CIHS
eligibility requirements are determined jointly by local board of trustees and the MCC Board of Trustees. The student must be
making appropriate progress toward high school graduation. 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
Check the Appropriate Program
College Transfer Pathway
Associate in Arts
A10100
Associate in Science
A10400
Other:
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 Martin Community College Counselor
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 also understand that there may be other fees
associated with my enrollment at Martin Community College.
I have read and understand the Martin Community College Code of Conduct and Attendance Policy.
Signature of Student
Date
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
MARTIN
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