APPLICATION FOR ADMISSION OR READMISSION

3CHECKLISTq Provide your Social Security numberq Provide your date of birthq Provide preferred phone contact

informationq Provide an active email addressq Sign the applicationq Pay $20 application fee, if new studentYour MCC acceptance letter will be

sent to the email address you provide on your application.

Admissions: 860-512-3210

Financial Aid: 860-512-3380 ma-finaid@manchestercc.edu

Veterans Services: 860-512-3375 veterans@manchestercc.edu

Mail the completed application to: Admissions Office, MS #12 Manchester Community College P.O. Box 1046, Manchester, CT 06045-1046

IMPORTANT DATES:Application: Recommended application deadline is no later than one month before the semester or session begins.*

Financial Aid: Priority deadline to be eligible for maximum grant aid is May 15 for fall; October 1 for spring.

Registration: Registration ends the day before the semester or session begins.

* Late applications will be accepted until the day before classes begin.

PR/10/17

www.manchestercc.edu

Banner ID @ ___________________________________________

Net ID _______________________ @ student.commnet.edu

CODES ASSOCIATE DEGREE MAJORSB11BA07 Accounting, Career Accounting Studies: CSCU Pathway Transfer B11BA05 Accounting & Business Administration, Transfer B12BG21 Art Studies: CSCU Pathway Transfer B12BG01 Biology Studies: CSCU Pathway Transfer Business Office TechnologyB11BA45 – Administrative Assistant, LegalB11BA46 – Administrative Assistant, MedicalB11BA44 – Administrative Assistant, OfficeB11BA67 Business Administration, CareerB11BA70 – Entrepreneurship OptionB12BG12 Business Studies: CSCU Pathway Transfer B12BG02 Chemistry Studies: CSCU Pathway Transfer B11BA53 CommunicationB11BA54 – Journalism OptionB12BG03 Communication Studies: CSCU Pathway

Transfer B11BC08 Computer Engineering TechnologyB11BA55 Computer Game Design B11BC12 Computer Hardware TechnologyB11BC10 Computer Internet Programming TechnologyB11BC09 Computer Network TechnologyB12BG13 Computer Science Studies: CSCU Pathway

Transfer B11BB03 Criminal JusticeB12BG04 Criminology Studies: CSCU Pathway Transfer B11BA18 Culinary ArtsB11BB06 Disability SpecialistB11BB18 – Speech-Language Pathology

Assistant OptionB11BF01 Drug and Alcohol Recovery CounselorB11BA06 Early Childhood EducationB12BG14 Early Childhood Teacher Credential Studies:

CSCU Pathway Transfer B11BA50 Engineering ScienceB12BG05 English Studies: CSCU Pathway Transfer B11BA30 Environmental ScienceB12BG15 Exercise Science Studies: CSCU Pathway

Transfer Finance Studies: CSCU Pathway Transfer B11BB17 Foodservice ManagementB12BG16 French Studies: CSCU Pathway TransferB11BB24 General StudiesB11BB27 Graphic DesignB11BB94 Health and Exercise ScienceB12BG06 History Studies: CSCU Pathway Transfer B11BA43 Hotel-Tourism ManagementB12BC18 Interpersonal & Organizational CommunicationB12BB68 Liberal Arts and Science, A.A.B11BB68 Liberal Arts and Science, A.S.B11BB84 Management Information SystemsB11BB71 Manufacturing Engineering Science

(Technology)B11BB72 Marketing Marketing Studies: CSCU Pathway Transfer B12BG07 Mathematics Studies: CSCU Pathway Transfer B12BC16 Music Studies

B11BB85 Occupational Therapy AssistantB11BA47 ParalegalB12BG19 Physics Studies: CSCU Pathway Transfer B12BG08 Political Science Studies: CSCU Pathway

TransferB12BG09 Psychology Studies: CSCU Pathway Transfer:B11BC73 Radiologic Science – Radiation Therapy – RadiographyB11BB88 Respiratory CareB11BA51 Social ServiceB12BG10 Social Work Studies: CSCU Pathway Transfer B12BG11 Sociology Studies: CSCU Pathway Transfer:B12BG20 Spanish Studies: CSCU Pathway Transfer B11BB96 Surgical Technology Technology StudiesB11BF15 – Computer-Aided Design OptionB11BF12 – Engineering Technology OptionB11BF19 – Industrial Technology OptionB11BC06 Therapeutic RecreationB12BA40 Visual Fine ArtsB12BA15 – Photography Option

CODES CERTIFICATE MAJORSB13BJ05 AccountingCode pending Advance Multiaxis CNC ProgrammingB13BK11 Computer–Aided Design (CAD)B13BK07 Computer Network TechnologyB13BK09 Computer Internet Programming TechnologyCode pending Coordinate Measuring Machine (CMM)

ProgrammingB13BJ10 CorrectionsB13BJ75 Criminal JusticeB13BJ77 Culinary ArtsB13BJ82 Dental AssistantB13BJ86 Disability SpecialistB13BK37 Electronic Health Records SpecialistB13BJ30 Entrepreneurship/Small BusinessB13BJ74 Fitness SpecialistB13BJ55 Forensic ScienceB13BK55 Health Career PathwayB13BJ06 Homeland SecurityB13BJ02 Hotel-TourismB13BN13 Lean ManufacturingB13BJ13 MarketingB13BJ14 Media Technology (Broadcast Media)B13BK02 Medical Insurance SpecialistB13BJ03 Office Support SpecialistB13BJ53 Paralegal B13BJ31 Photography B13BJ68 Precision ManufacturingB13BK04 Professional BakerB13BJ51 Public RelationsB13BJ35 Social ServiceB13BJ39 Therapeutic RecreationB13BJ58 Web Technology

Degree and Certificate Majors and Codes

Continuing Notice of Nondiscrimination: Manchester Community College does not discriminate on the basis of race; color; religious creed; age; gender; gender identity or expression; national origin; marital status; ancestry; present or past history of intellectual disability, learning disability or physical disability; veteran status; sexual orientation; genetic information or criminal record. The following person has been designated to respond to inquiries regarding the non-discrimination policies: Debra Freund, Chief Diversity Officer (Title IX and Section 504/ADA Coordinator), Manchester Community College, Great Path, MS #9, P.O. Box 1046, Manchester, CT 06045-1046, SSC L277. Manchester Community College is an Affirmative Action/Equal Opportunity Employer and strongly encourages the applications of women, minorities, persons with disabilities, and veterans.

Continuando con el Aviso Anti-Discriminatorio:Manchester Community College no discrimina por motivos de raza; color; religión; cre-do; edad; sexo; nacionalidad; identidad de género o expresión; origen nacional; estado civil; ascendencia; historial presente o pasada de discapacidad intelectual, discapacidad de aprendizaje o discapacidad física; estatus de veterano; orientación sexual; información genética o antecedentes penales. La siguiente persona ha sido designada para responder consultas relacionadas a nuestra póliza anti-discriminatoria: Debra Freund, Directora de Diversidad (Título IX y la sección 504/ADA Coordinador) en Manchester Community College; Great Path, MS#9, P. O. Box 1046, Manchester, CT 06045-1046; SSC L277. Manchester Community College está bajo el plan de Acción Afirmativa / Empleador de Igualdad de Oportunidades y alienta encarecidamente las aplicaciones de mujeres, minorías, personas con discapacidad y veteranos.

The college reserves the right to make any necessary changes in the information listed in this publication.October 2017/5M/PRAlternative formats of this material may be provided upon request.

What Do I Need to Do?

NEW STUDENTSNever attended another college

1. Apply for admission, $20 application fee*

2. Apply and follow up with financial aid

3. Provide required documents by start of semester • Vaccination records (MMR and varicella)• Proof of high school completion

4. Register online to take the assessment test

5. Register online to attend New Student Orientation.• You will register for classes at

New Student Orientation

6. Finalize payment

TRANSFER STUDENTSAttended another college

1. Apply for admission, $20 application fee*

2. Apply and follow up with financial aid

3. Submit all prior college transcripts • Official for transfer of credits • Unofficial for proof of prerequisite(s)

4. Meet with an advisor• Transcripts must be reviewed by

Admissions before meeting with an advisor (if not from Community College system)

5. Register for classes

6. Finalize payment

NON-DEGREE SEEKING STUDENTS1. Apply for admission

2. Provide proof of eligibility for classes (transcripts, SATs, etc.)

3. Register for classes

4. Finalize payment

* No application fee if previously applied or attended any Connecticut community college

n Fall (Aug-Dec)

n Spring (Jan-May)

n Winter (Dec-Jan)

n Summer (May- Aug)

FOR OFFICE USE ONLYReceived Date _____/_____/________

BANNER @ __ __ __ __ __ __ __ __

Admit Type ____________________

Student Type ___________________

Entered By ____________________

Entered Date_____/_____/________

Application Fee Paid ¨ Yes ¨ No

Cash _________ Check #______________

Money Order_________ Waived__________

Credit/Debit Card

___________________________

Exp. Date _____/_______

APPLICATION for ADMISSION(Please print legibly in blue or black ink)Manchester Community College

n Yes n No

nn White (10) nn Black or African American (20)

nn Asian (45)

nn American Indian or Alaskan Native (50)

nn Native Hawaiian or Other Pacific Islander (80)

Do you consider yourself to be Hispanic/Latino?

What is your race? (Select one or more)

This information is requested on a voluntary basis by the U.S. Department of Education, National Center for Education Statistics. Your answer will not affect admission to or registration in the college.

ETHNICITY/RACE

nn Neither attended collegenn One or both attended college but did not earn a degree nn One or both earned an associate degreenn One or both earned a bachelor’s degree or higher

Check the category that applies to your parent(s) or guardian(s):

FAMILY EDUCATIONAL BACKGROUND

If no, are you a permanent resident? (green card holder) Are you a United States citizen?

CITIZENSHIP

n Yes n No

n M n F

n Yes n No

Are you currently on active duty with the U.S. Armed Forces?Are you currently a member of the National Guard or Reserve?

Have you ever served in the U.S. Armed Forces?Are you a dependent of a member of the U.S. Armed Forces?

If you answered “Yes” to any of these questions, you may be entitled to benefits and should meet with the college’s Veterans Certifying Official (VCO).

MILITARY STATUS

n No

n No

n No

n No

n Yes

n Yes

n Yes

n Yes

(ACTD)

(NGRE)

(VET1)

(VETD)

1. Are you eligible for in-state tuition because you have continuously resided in Connecticut for at least one year and Connecticut is your permanent home?

2. If “No,” can you claim and demonstrate through documentation that you are eligible for in-state tuition?

3. Check here if applying under the New England Regional Student program (NEBHE).

Out-of-state students may be eligible for a reduced tuition rate through the NEBHE program. For details, see the college catalog or website.

If you answered “Yes” to question #2 or checked question #3, you must submit a “Declaration of Eligibility for In-State or NEBHE Tuition” for review and determination of eligibility.

IN-STATE TUITION

n Yes n No

n Yes n No

n NEBHE

Have you previously attended a CT Community College?

Have you previously attended this college?

Are you transferring from another college?

n Yes n No

n Yes n No

n Yes n No

For which semester are you applying?

n Summer continuing into fall

ATTENDANCE & APPLYING

CONTACT INFORMATION

If yes, where?

Year

If yes, when?

Number & Street Apt. # City State Zip

Number & Street Apt. # City State Zip

Cell Phone Home Phone Work Phone

MailingAddress

PermanentAddress

PhoneNumbers

(MM) (DD) (Year)

( ) - ( ) - ( ) -

Legal Last Name Legal First Name Middle Previous Maiden/Last Name

Social Security Number Date of Birth Gender

Email

(Social security number requested for purposes of financial aid, federal income tax benefits, provision of some college services, accuracy of student records and other business purposes.)

College/University Name State

Dates of Attendance Graduation Date Degree Awarded

College/University Name State

Dates of Attendance Graduation Date Degree Awarded

College/University Name State

Dates of Attendance Graduation Date Degree Awarded

Signature

Signature

Email CommunicationsI request the college forward me any initial correspondence to the email address I have provided, including personally identifiable information pertaining to me from college records protected by FERPA.

Consent for the Disclosure of Education RecordsI understand that to maintain accurate student records, including the records pertaining to my attendance at the college, and for other necessary business purposes, the college may need to release or provide access to personally identifiable information in its records pertaining to me to another college in the CT Community College System or to the system’s administrative office. Accordingly, I hereby authorize the college to release or allow access to such information to those indicated for the purposes described.

I certify with my signature below that I am the applicant and that the information I have provided above is accurate. If admitted, I pledge to comply in good faith with all the rules and regulations of the college. I realize that any misleading information provided by me on this application may be cause for dismissal. I understand that information collected in this application is for reporting purposes only and will not be used in the selection process for admission.

INTENDED PROGRAM OF STUDY

In which degree/certificate program do you plan to enroll? (use attached list)

INTERNATIONAL STUDENT INFORMATION

Are you an international student who needs an I-20 form for an F1 Visa?n Yes n No

HIGHEST EDUCATIONAL LEVEL ACHIEVED

nnNo high school diploma or GED (01)

nnHigh school diploma or GED (02)

nnSome college (06)

nnUndergraduate certificate (05)

nnAssociate degree (07)

nnBachelor’s degree (08)

nnMaster’s degree (09)

nnOther advanced degree (10)

nnDoctoral degree (11)

nnFirst professional degree (JD, MD, DDS, LLB) (12)

nnSixth-Year certificate (13)

Check only one

EDUCATIONAL GOAL

nnDevelopmental (college prep) education (DV)

nnEnglish skills (ESL) (ES)

nnCertificate - undergrad credit (CT)

nnFulfill other college’s requirement (AC)

nnTransfer without an associate degree (DN)

nnAssociate degree (DG)

nnEarn associate degree, then transfer (DT)

nnPersonal development course(s) (PD)

nn Job preparation/retraining course (JB)

nn Job promotion (JP)

nnUnsure at this time (UN)

nnGoal not listed (NL)

Check only one

ACADEMIC BACKGROUND

n Yes n No n Pending

n Yes n No

n Yes n No

n Yes n No n Yes n No

Do you have a high school diploma?

Have you passed the high school equivalency exam GED, TASC, HiSET? (070997)

Are you a home school graduate? (I00001)

Have you participated in the High School Partnership Program through the CT Community Colleges?

Have you taken courses at your high school and earned college credit? (concurrent enrollment)

Please submit a copy of your final official high school transcript or equivalency credential.

PREVIOUS COLLEGES ATTENDED

COMMUNICATION & CONSENT

Other Visa Holder (indicate type)

Visa Admission Number

International Address

Visa Start Date

Visa End Date

Year Town/State

Grad Year Town/State

Primary Major Code

Secondary Major (optional) Code

Signature Date

Parent/Guardian Signature (if under 18) Date

Name of High School Graduation Year

City/State Country