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Information Request


Please tell us about yourself:

First Name:
Last Name:
Street 1:
Street 2:
City:
State:
Zip code:
Phone:
Email:
Verify Email:

Would you prefer to recieve correspondence from MHCC:

Electronically or Through the Mail

Date of Birth:

U.S. Social Security Number:

Why do you need my Social Security Number?

NOTE: Providing your social security number allows us to keep your records accurate and up-to-date. Providing your social security number is voluntary. If you provide it, the college will use your social security number for keeping records, doing research, aggregate reporting, extending credit and collecting debts. Your social security number will not be given to the general public. If you choose not to provide your social security number, you will not be denied any rights as a student. Please read the statement on page 8 of your class schedule which describes how your number will be used. Providing your social security number means that you consent to use of the number in the manner described.

Gender  
Male Female
Ethnicity:
Tell us about your educational experience:
I am currently a high school student.
High School:
Intended date of Graduation:
I currently attend another college or university.
College:
I am an adult learner
  Returning to college
  Going to college for the first time.

I plan to enroll: Summer   Fall   Winter   Spring

Year expected to enroll:

Please send me:

General Information:

Please send me:

Academic Program Information:

I am interested in MHCC because:

How did you hear about MHCC?

If College Fair above, which fair?

If Job Fair above, which fair?

If Campus Event above, which event?

If you selected Other above, how did you hear of MHCC?

Any Additional comments?

Thanks your for your interest. While you are waiting to receive your information, feel free to use our website as a resourse: www.mhcc.edu

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