High School Admissions Application

If you need assistance with this form, please contact the MCC staff member at your local high school.

All yellow fields are required

Name

Please use your full and legal first and last names








General Information


MM/DD/YYYY format


If you do not have a social security number enter all zeros.

Ethnicity/Race

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following question(s)


American/Alaskan Native
Asian
Black or African
Native Hawaiian or Other Pacific Islander
White

Contact Information



IMPORTANT: Enter your e-mail address to receive important information about Mohave Community College. Once enrolled this will authorize MCC to send information such as registration information, academic performance, financial aid, disbursement eligibility, billing statements, charges, and past due amounts to this e-mail account.

Please be sure to include area code
OR

(At least one phone number is required)
Please be sure to include area code


Please be sure to include area code

Mailing Address








Enrollment Information








Citizenship

Student must be prepared to provide evidence of citizenship, permanent residency or other lawful immigration status.

Residency Status

To be considered an Arizona resident for tuition purposes, you must have resided in the state continuously for at least 12 months prior to submitting this admission application.

High School Information



Student Support Documentation

In order to determine your appropriate tuition rate, MCC asks for you to upload a government-issued photo ID and Social Security Card. All students are initially defaulted to our Out-of-State tuition rate until documentation has been submitted and reviewed.

If you are unable to provide the necessary documents now, you will receive an email from Enrollment Services directing you to scan required documents into the MCC secure site. Required documents may include any of the following: Social Security card, Driver's License, Permanent Resident Card, Visa, Foreign Passport. All applicants are considered out-of-state students until Residency and Citizenship documents have been reviewed by Enrollment Services. Once documents have been reviewed, your tuition status will be determined.

For questions regarding acceptable documents, please email enrollmentservices@mohave.edu.

Acknowledgment

By submitting this form, I hereby certify that, to the best of my knowledge, the information furnished is true and complete without intention of evasion or misrepresentation. I understand the above information submitted is under penalty of perjury, and false or misrepresentative data is sufficient cause for rejection of this admission form.
By submitting this application, I agree to abide by the student rules and regulations of the institution regarding conduct and other obligations during my time with Mohave Community College.
I have read and understand the paragraph above (required)

Student Registration Agreement

I understand that:

MCC is advancing value to me in the form of educational services and my right to register is expressly conditioned upon my agreement to abide by the college academic and financial policies and to pay the cost of tuition, fees and any additional costs when those charges become due.

Regardless of my eligibility for financial aid, VA education benefits or any 3rd party promissory notes, I am personally responsible for the full amount assessed to me as a result of my registration and attendance.

Failure to pay tuition and fees will result in a hold on my record that prevents participation in registration and academic activities (attending classes, adding or withdrawing from classes, etc.)

If I am utilizing the third-party provider for payment plans, missing ANY scheduled payment results in immediately paying the entire balance due or I will be administratively withdrawn from all my classes.

Should my account become delinquent, MCC reserves the right to transfer my account to Arizona Department of Revenue (AZDOR), a contracted collection agency, attorney and/or credit bureau. I will be held responsible for collection costs, including any fees charged by AZDOR, the collection agency and attorney's fees in addition to my outstanding balance. I authorize MCC and its agents to utilize all contact information to collect any debt I owe to MCC, (including, but not limited to cell phone numbers and email addresses I have provided to the College, etc.)

MCC will apply any financial aid I receive, including grants, loans and scholarships to tuition and fee charges assessed to my account.

I must follow the formal add/drop and withdrawal procedures of MCC.

MCC will deliver my IRS Form 1098-T electronically every year I have reportable transactions. Students will receive notification when their 1098-T is available along with instructions on how to access the form.

Dropping or withdrawing from a class may impact my Financial Aid and generate charges I must pay due to funds being returned to federal and state financial aid programs and/or scholarship donors. My graduation date may also be impacted. I should discuss consequences with my advisor before dropping or withdrawing from a class.

Dropping, withdrawing from or being administratively withdrawn from my course(s) may impact my funding if I am receiving VA education benefits. I should discuss the impact with an advisor or the veteran services coordinator before making any changes.

I will be administratively dropped from class if I fail to attend (on-ground courses) or participate (online courses), or contact the instructor, during the first calendar week after the official start date, or within seven days of my registration if I register after the official start date.

I may be administratively withdrawn after three consecutive weeks of non-participation, following the first week of the class. This can affect my financial aid or VA education benefits.

Mohave Community College does not discriminate on the basis of race, color, ethnicity, national origin, gender, sex, age, religion, gender identity, gender expression, disability, or sexual orientation in its educational programs and activities or employment practices. For more information on discrimination issues or to file a complaint, I can contact my campus dean or visit https://www.mohave.edu/about/safety/# . More information can be found regarding Title IX at http://knowyourix.org/
I Agree (required)

What's Next?

Once your application has been processed your MCC ID number will be emailed to you along with a link to register for Student Orientation and the next steps needing to be taken in order to register for classes.



Title IX is a federal law that makes it illegal to discriminate against a person on the basis of sex in any federally funded activity.

Title IX Coordinator
Danette Bristle

dbristle@mohave.edu
TitleIX@mohave.edu
Wk: 928.704.9480
Cell: 928.542.6920
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