STUDENT INFORMATION
CURRICULUM
SIGNATURE
Registrars Office
Declare of Major/Change in Curriculum
First Name MI Last Name
Are you applying for financial aid or veterans benefits? Date of Birth Banner ID Number
Please complete this form, sign, date and mail to: Manchester Community College, Registrar’s Office, Great Path, MS #13, P.O. Box 1046, Manchester, CT 06045-1046
or fax this form to 860-512-3221.
Mailing Address
City State Zip
Home Phone Number Cell Phone Number Work Phone Number
Student Signature Date
August 2017/PR
New Curriculum/Major Please select only one designation.
n
A.S. Degree
n
A.A. Degree
n
Certificate
n
Yes
n
No
FOR REGISTRAR OFFICE USE ONLY
Date Student Record Updated _____/_____/________
High School Transcripts/Diploma ¨ Yes ¨ No Immunizations ¨ Yes ¨ No
In order to process your request, we must have on file:
1. Your high school transcript or a copy of your original high school diploma.
2. Documentation of two each of measles, mumps, Rubella and varicella (chickenpox) vaccines administered at least one month apart.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome