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Student ID#

(If you do not have a student ID you must enroll at MCC before filling this form out)

First name

Middle Name

Last name

Email

Street address

City

State

ZIP code

Date of Birth

(MM/DD/YYYY)

Cell phone number

(cell phone number is required)

Other phone number

Will you use financial aid, student loans, or scholarships for schooling? Yes No

(please keep in mind that a $2,800 self-funding Tool/Boot cost outside of Financial Aid will be necessary three months before the program begins)

Check all that apply for Prospective student I have an immediate Family member in the Utility industry Military I applied another year and was put on the waitlist I received one or more industry-related Scholarship(s) for school I am being sponsored by an Industry Partner Previously worked with a Utility None of the above

Check all that apply for CDL Commercial Learners Permit Commercial Driver's License with restrictions No CDL

Year graduated high school

Location of high school

Comment

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