Fillable Form 49017.: (Kellogg Community College)

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Form 49017.: (Kellogg Community College)

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The Form 49017.: (Kellogg Community College) form is 1 page long and contains:

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  • 7 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Kellogg Community College

BROWSE KELLOGG COMMUNITY COLLEGE FORMS

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Please complete all areas of the form. All information provided is kept strictly confidential. Application may be
submitted online, by mail, e-mail, or by fax. Fax application to (269) 565-2060. E-mail application to crju@kellogg.edu.
Mail application to: Kellogg Community College, Criminal Justice Programs, 450 North Ave, Battle Creek, MI 49017.
Test Fee is $45 and is payable by Credit or Debit Card Only. Application deadline is 4:00pm the Wednesday before
each test. Cancellations for a refund must be received by that time. All payments will be processed on Thursday or
Friday prior to the test. All fitness tests will be conducted at the KCC Miller Gym, 450 North Ave., Battle Creek, MI
49017.
Submitting this form does not qualify as confirmation; we will e-mail you to confirm your registration. Please contact
us by Wednesday prior to the test date if you do not receive a confirmation email. Kellogg Community College will
notify you by e-mail or phone if the session is cancelled due to inclement weather or low enrollment. A recorded
message regarding cancellation will be available the Thursday before a test at 269-660-7703.
Please TYPE or PRINT the following information:
Applicant Information
Name Last
First
MI
Address Street Number/Name
City
State
Zip
Phone Number
Email Address
Requested Test Date (Please Check One)
Saturday, June 13, 2020 @ 11:30 am
Saturday, June 20, 2020 @ 11:30 am
Saturday, June 27, 2020 @ 11:30 am
NOTE: The Public Safety Education office is closed on Fridays in June and July.
PLEASE NOTE THE START TIME FOR EACH TEST DATE
The information on this form has been provided by me and is true and complete to the best of my knowledge. I agree to provide proof of
any information if it is requested. I understand that false/or misleading information may lead to loss of course credit, loss of tuition and
fees paid, dismissal from KCC and/or criminal action.
I have read the above statement and agree.
Payment
Credit/Debit Card – Please fill in all areas of the following form.
Amount to charge: $
Card Type:
Card Number:
Pin
(3 or 4 digits on back of card)
Expiration Date:
Cardholder’s Name:
For Office Use Only
For Business Office Only - $45 Application Fee
Date Rec’d.
Please deposit by applicant name to Account #04-0701-159900-834
MCOLES Physical Fitness Test Application
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Form 49017.: (Kellogg Community College)

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Completed 18 September 2020

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