Admissions Application 2010 11

8/8/2019 Admissions Application 2010 11

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Montgomery College

Applicationfor Admissions


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Print clearly, in ink; complete both pages. Enclose check or money order for $25 nonrefundable fee; starter checks are not accepted.

Have you previously applied to MC? Yes NoHave you ever taken credit or noncredit courses at MC? Yes No

NAME Last First Middle

CURRENT ADDRESS Street

County of Residence City State ZIP

HOW LONG HAVE YOU LIVED AT THIS ADDRESS? Years Months

PERSONAL INFORMATION Not used for admission. Federal regulations require colleges to report enrollment data by racial, ethnic, and gender categories.

BIRTH DATE

YesETHNICITY/RACE No

White[1] Black or African American[2] Asian[4] American Indian or Alaskan Native[5] Native Hawaiian or Pacif ic Islander[7]

FOREIGN STUDENT STATUS For resident tuition eligibility, an applicant who is not a U.S. citizen must show proof of status (e.g., employment authorization card orpassport); not all statuses qualify. In the absence of documentation, student is charged out-of-state tuition and fees.

U.S. Entry Date I-94 Departure/Expiration DateImmigration Status (I-94)

Nation of Birth Nation of Citizenship

1. Do you plan to request an F1 (student) visa while outside the U.S.? Yes* No

2. Do you plan to request a change of status to F1 while remaining in the U.S.? Yes** No

3. Do you have an F1 visa or F1 status through another school? Yes No

a) If yes, list school on current I-20

b) Do you plan to transfer your F1 status to Montgomery College? Yes* No

c) Do you plan to enroll at Montgomery College as a visiting student and maintain F1 status at your home school? Yes No

**If 2 answered Yes, see an internationalstudent coordinator before submitting this application.

*If 1 or 3b answered Yes, complete additional

application procedures atwww.montgomerycollege.edu/admissions/I20 or

contact an international student coordinator.

SOCIAL SECURITY NUMBER

E-MAIL

HOME PHONE

Country (if not U.S.)

Expiration date of current I-20

Month / Day / Year

WORK PHONE

CELL PHONE

MaleGENDER Female

CITIZENSHIP U.S. If you are a permanent resident or a non-U.S. citizen, complete FOREIGN STUDENT STATUS section below.

HIGH SCHOOL Name of High School or Home School Organization

City State or Country (if not U.S.)

Anticipated/actual high school or GED completion Month

High School Diploma Recipient

Current High School Student

Maryland GED Recipient

High School Non-graduate

Years Attended from to

Year

Are/were you home schooled? Yes NoIf Yes, fill in home school information above, includingcompletion month and year.

Did you complete a Tech Prep Program? Yes No

M- ____ ____ ____ ____ ____ ____ ____ ____

Office Use Only

Are you of Hispanic or Latino origin? What is your race? Select one or more of the following categories:

Permanent Resident

Check one:

High School Certificate Recipient

Non-Maryland GED Recipient

Previous Name(s)

Your Social Security Number is not required for admission. However, if you intend to applyfor financial aid or claim tuition and fee costs on income taxes, you must provide your SSN.Under 16

EMERGENCY CONTACT Last Name First Name

Phone Relationship

Application continues on next page.

Montgomery College Admissions Application 1 of 2


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Montgomery College Admissions Application 2 of 2

List accredited U.S. college or university previously attended

Do you have an associates/bachelors degree from a U.S. college or university?

Yes No

Have you completed a college-level English composition course with a grade of C or better at an accredited U.S. college or university?

If yes, list college or university, course number, and title

Yes No

COLLEGE

PROGRAM OF STUDY Check one box that best describes your current educational goal. Find the 3- or 4-digit code for your major,located in the Montgomery College Programs of Study list. Enter the code in the Desired Major box to the right.

1. I plan to earn an associates degree at Montgomery College. F1/M1 visa applicants must check this box.

2. I plan to earn a certificate at Montgomery College.

3. I plan to transfer/seek a degree from another institution.

4. I do not plan to pursue a degree; I plan to take courses for personal interest. (Students who select this category are not eligible for

financial aid. This option is typically limited to students who have been out of high school or its equivalent for at least three years.)

SIGNATURE I certify that the information on this application is correct and complete; I understand that falsification may result in dismissaland/or retroactive adjustment of tuition and fees. I certify that I am aware of Montgomery Colleges (MC) policy on drug and alcohol abuse

prevention, and that MC is a tobacco-free institution and thus prohibits the use of tobacco products on all MC-owned property. If admitted,I agree to abide by policies and procedures of MC (http://cms.montgomerycollege.edu/pnp). Additionally, I understand that I am responsible

for all costs including collection costs to satisfy my debts to MC. Upon request by a designated MC official, I agree to provide evidence of

the information on this application for verification.

Applicant Signature Date Parent/Guardian Signature Date(required when applicant is under 18 years of age)

Montgomery Col lege i s an academic ins ti tu tion commit ted to promoting equal oppor tuni ty and fos tering d iversi ty among i ts s tudents, facul ty , and s ta ff . AEM 05/10

M- ____ ____ ____ ____ ____ ____ ____ ____Initial & Date:

Office Use Only

Desired Major

FallTERM Winter Spring Summer

When do you plan to attend MC?YEAR GermantownCAMPUS RockvilleTakoma Park/Silver Spring

LANGUAGE BACKGROUND FOR ASSESSMENT TESTING Most students are required to take placement tests. The Accuplacer test is forstudents whose first language is American English or those who have attendeda U.S. school for 10 or more years. All other students take the ESL Accuplacertest designed for students who speak American English as a second language.

Both assessment tests may lead to college-level courses.

Was American English the first language you spoke at home? Yes No

Have you attended 10 or more years of school in the U.S.? Yes No

5. I am a visiting student from another college/university. (Submit permission to enroll from your home institution; include approved

MC course numbersfor example, EN101)

Did you take the SAT or ACT? Yes No If yes, submit an original score report; faxes and copies are not accepted.

U.S. MILITARY STATUS (if applicable)

Air Force

VeteranActive Duty Dependent of Active Duty Servicemember or Veteran

Army NavyCoast Guard ReservesNational GuardMarine Corps

FAMILY EDUCATION BACKGROUND

Did your mother attend college?

DoctoralAssociates Bachelors Masters

No Degree

Yes No

Indicate highest degree obtained by mother:

Did your father attend college?

DoctoralAssociates Bachelors Masters

No Degree

Yes No

Indicate highest degree obtained by father:

1. Do you/your parents own/rent your primary residence? YesNo If yes, list County State

2. Do you file income taxes? YesNo If yes, filed in County State

4. Are you registered to vote? YesNo If yes, registered in County State

3. Do you own a motor vehicle? YesNo If yes, registered in State

5. Do you have a valid drivers license? YesNo If yes, issued in State

RESIDENCY FOR TUITION PURPOSES

(Provide an unofficial transcript to Admissions to have required English assessment test waived.)

(Provide an unofficial transcript to Admissions to have required assessment tests waived.)

OTHER How did you learn about Montgomery College?

Direct MailRideOn Bus Ad Friend or FamilyHigh School EventCampus Event Other Community Event

Newspaper Ad Radio Television Movie Theatre Ad

M - ____ ____ ____ ____ ____ ____ ____ ____

Web Ad

Please submit your application and $25 application fee to one of our campuses:Germantown Campus20200 Observation Drive, Germantown, MD 20876

Rockville Campus51 Mannakee Street, Rockville, MD 20850 Takoma Park/Silver Spring Campus 7600 Takoma Avenue, Takoma Park, MD 20912


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Montgomery College What You Need to Know

Once my Montgomery College application is processed, what comes next?Promptly complete any remaining assessment/testing requirements. Most courses require that you demonstrate skill levels in

English, reading, and/or mathematics prior to registration. Contact the Assessment Center or testing times or appointments.

Why is the welcome letter so important?The welcome letter contains your M number, your MyMC ID, your ofcial College e-mail address, residency/tuition rate,

and which placement test you should take. I you have not received this letter within fve business days ater applying toMontgomery College, contact the Response Center at 240-567-5000. Keep your welcome letter or your records.

What is an M number?An M number is your student identifcation numberalso called your College ID, assigned to you by Montgomery College.

What is a MyMC ID?Your MyMC ID is the user ID assigned to you or entry to Montgomery Colleges Web portal MyMC, where you can read

your e-mail, register or classes, contact your instructors view your grades, and learn about clubs, news, and activities at MC.

How do I log in to MyMC?Now that you have your MyMC ID rom your welcome letter, visit the MyMC site at http://mymc.montgomerycollege.edu or

click on the MyMC button on Montgomery Colleges home page to take you to MyMC. Beore you log in to MyMC, ollow theinstructions provided on the site. Ater you log in, you will be prompted to immediately change your password. I you need

help with MyMC, call 240-567-5000, choose option 1 or English, and then option 2 or MyMC. Warning: Do not share your

login information with anyone. You will be responsible for all transactions on this account.

Will I get a Montgomery College student e-mail account?Yes. Your MyMC ID is your e-mail account name. (Format: [email protected]). Your e-mail account is used as

an ofcial means o communication between you and Montgomery College. Check your e-mail requently or inormation includ-

ing waitlist status, course announcements, registration inormation, payment notices, College closings, and class cancellations.

Important Phone Numbers and ContactsAdmissions and Records 240-567-5000

Financial Aid 240-567-5100

Assessment/Placement TestingGermantown Campus 240-567-7739

Rockville Campus 240-567-7459

Takoma Park/Silver Spring Campus 240-567-1555

BookstoreGermantown Campus 240-567-7877

Rockville Campus 240-567-5302

Takoma Park/Silver Spring Campus 240-567-1522

CashierGermantown Campus 240-567-7836Rockville Campus 240-567-5342 Takoma Park/Silver Spring Campus 240-567-1526

Counseling and AdvisingGermantown Campus 240-567-7734Rockville Campus 240-567-5063 Takoma Park/Silver Spring Campus 240-567-1480

Disability Support ServicesGermantown Campus 240-567-7770Rockville Campus 240-567-5058 Takoma Park/Silver Spring Campus 240-567-1475

For additional help and support, call the Response Center at 240-567-5000.

Germantown Campus20200 Observation DriveGermantown, MD 20876

Rockville Campus51 Mannakee StreetRockville, MD 20850

Takoma Park/Silver Spring Campus7600 Takoma AvenueTakoma Park, MD 20912

Keep this page for your records.

www.montgomerycollege.edu


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CHOOSE AMONG THE 40 BEST UNDERGRADUATE DEGREE AND

CERTIFICATE PROGRAMS FROM ACROSS THE STATE

ENJOY SMALL CLASSES, ONEONONE CONTACT WITH

TOP FACULTY, AND PERSONALIZED STUDENT SERVICES

ATTEND ROCKVILLE CAMPUS WITH THE OPTION OF FULL- ANDPART-TIME PROGRAMS

TIPS FOR A SMOOTH TRANSITION TO USG FOR YOUR

BACHELORS DEGREE

Meet with a Montgomery College counselor to determine what

curriculum or major best suits you and your career goals.

Determine, with the counselor, i a program at the Universities at

Shady Grove is right or you, or meet with a USG academic advisor.Call 301-738-6023.

Explore the Transer Access Programs (TAP) oered by some University

System o Maryland institutions. TAP guarantees early admission to the

participating institution and while at MC, the student receives other

benefts as well, such as access to academic advising, scholarship

opportunities, and tuition discounts.

Follow the transer program o study or your selected major. For a

smooth transer, make sure you meet the admissions criteria and you

take the right courses during the frst two years.

Visit the USG campus. Either attend a recruitment event or schedule a

meeting with a USG academic advisor. Go to www.shadygrove.umd.edu/

students/prospective.

Apply to the program o choice oered at USG. At the same time, apply

or fnancial aid and scholarships oered exclusively or students who

attend programs at USG. Go to www.shadygrove.umd.edu/scholarships.

Todays Possibilities Lead To Tomorrows Successes

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Bowie State University

Salisbury University

Towson University

University o Baltimore

University o Maryland, Baltimore

University o Maryland, Baltimore County

University o Maryland, College Park

University o Maryland Eastern Shore

University o Maryland University College

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BIOTECHNOLOGY

BUSINESS

COMMUNICATION

COMPUTER INFORMATION SYSTEMS

& TECHNOLOGY

CONSTRUCTION MANAGEMENT

TECHNOLOGY

CRIMINOLOGY & CRIMINAL JUSTICE

EDUCATION

EMERGENCY MANAGEMENT

HEALTH SYSTEMS MANAGEMENT

HISTORY

HOMELAND SECURITY MANAGEMENT

HOTEL & RESTAURANT MANAGEMENT

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PSYCHOLOGY

PUBLIC HEALTH SERVICES

RESPIRATORY THERAPY

SIMULATION & DIGITAL ENTERTAINMENT

SOCIAL WORK

9630 Gudelsky Drive, Rockville, MD 20850 301.738.6023 www.shadygrove.umd.edu

Documents

Admissions Application 2010 11