Program Application – Full-Time Student
Only students who wish to enroll full-time in the MAP Program need to apply.
PLEASE PRINT CLEARLY USING BLUE OR BLACK INK
APPLICANT’S LEGAL NAME (Last) (First) (Middle)
BIRTH DATE (Month/Day/Year)
CURRENT MxCC STUDENT?
□ Yes □ No
MxCC New Student
Application must also be
on file.
ADDRESS (No. and Street) (Apt. #) (City or Town) (State) (Zip Code)
HOME TELEPHONE (Area Code)
COMMUNITY COLLEGE E-MAIL ADDRESS (all emails will be sent to your new community college email address. You can look up your new email
address in myCommNet.)
Middlesex CC Application for Admission
Placement into English Composition (ENG*101)
Placement into Intermediate Algebra (MAT*137) or higher
Essay
In 500 words or less, describe how your history – academic or personal – has prepared you for an accelerated
Associates degree program. Also describe how an accelerated Associates degree program will help you reach
your personal, professional, or educational goals.
Official High School Transcripts
College Transcripts (If applicable)
ACT and/or SAT scores (if applicable)
Degree Program: Criminology, Criminal Justice, Liberal Arts, General Studies, or Business Studies
I have provided true, correct, and complete information. I realize that any misleading information on this application
may be cause for dismissal. I request the college forward to me at the email address I have provided all
correspondence, including personally identifiable information pertaining to me from College records that is
protected by FERPA.
Signature:
Date:
Completed applications should be submitted along with all required materials to:
Office of Enrollment Services
100 Training Hill Road
Middletown, CT 06457
