Montcalm Community College Registration Form For Credit Classes -
PRINT A FORM FOR EACH SEMESTER FOR WHICH YOU ARE ENROLLING 

Refer to "Registration" for mail and phone-in dates and times.

Indicate semester: _____Fall _____Spring _____Summer

Last 4 digits of Social Security # _____________ Student ID# ____________________

Name: _____________________________________________________________________________
               Last                                                                First                                        M.I.                  Maiden
Address:   __________________________________________________________________________
                        Number & Street (P.O. Box # alone is not sufficient)                           P.O. Box
___________________________________________________________________________________
City                                                                                    State                                                         Zip

(__________)_______________________________    (___________)__________________________
Home Phone #                                                                                             Daytime Phone #

E-mail Address: _____________________________________________________________________

Please place a check mark before the school district in which you reside:
___Carson City/Crystal             ___Central Montcalm             ___Greenville
___Lakeview                               ___Montabella                         ___Tri County
___Vestaburg                              ___Other (please indicate)___________________________________

Is this your first enrollment in any college?     ___ yes    ___no
Is this your first enrollment at MCC?                ___yes      ___no

OPTIONAL:
Race: (check one)       ___White       ___Black      ___American Indian       ___Asian       ___Hispanic
                                  ___Other __________________________
Gender: (check one)     ___Female        ___Male             Birthdate:   _______/__________/_______

Year graduated from:    High School _________ or Adult High School ________ or GED earned ________

Name of high school graduated from or where GED was completed: ______________________________

Do you plan to enroll at MCC for the semester following this one?
___ Yes    ___ No                         If no, in the future?    ___Yes    ___No

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