MCC Admissions

Application for Admission

Please enter the necessary information for ALL items that apply to you to speed your application.

Items in Blue are required to process your admission.

Personal Information:

Today's Date

Social Security#:
(International students must use 999-99-9999 in this blank for the form to be submitted unless you already have a social security number.)

Last Name:

First Name: (legal)
First Name: (preferred)
Middle:
Birth Name: (if different from above)
Last name/other name on your previous academic transcripts

Permanent address:

Number/street City
State Zip
Country

Current address: (if different)
Number/street: City
State/Country: Zip

Contact Information:

Home Phone (Area code & number)
Work Phone (Area code & number)
E-mail address:
Cell Phone (Area code & number)

Parent Information:
Parent/Guardian: (if student is under age 21)
Parent's Address:
Number/street City
State/Country Zip:
Of your parent(s), which one has the most education?
Please indicate level of education:

Ethnic Information: (Optional)

Gender:

Birth date:

Residency Information:
Are you a U.S. Citizen?
If no, are you a permanent resident of the U.S.?
If no, indicate type of Visa:
If yes, print your alien registration number:
Country of citizenship, if you are not a U.S. citizen:

Iowa Residency Statement:
I have been a resident of Iowa since birth.
I have been a permanent resident of Iowa since (month and year)
I am a resident of (state)

Admission Information:
At which location will you attend classes?
Term Beginning:
Student Status:

Degree and Major:
What are your educational plans? (Check any that apply)
Enrolling for Summer Classes only
Taking one class only

Degree Information:
Degree you're planning to seek (Please select only one degree. If you cannot find an exact match for your interests, select the closest one. You will be able to change later if you change your mind or your circumstances.)

Educational Information:
Did you graduate from high school?
What Year? What Month?
High school attended City/State
Are you currently in high school?
Are you Home Schooled?
Have you taken the GED? Year

Please have your high school transcript or or GED scores mailed directly to us from the school. Faxed transcripts or transcripts issued to students are NOT considered official. This is not required for those taking only one MCC class.

List all other colleges/universities you've attended. (Remember to contact each school and ask that an official transcript be sent to MCC as soon as possible.)

Name of Institution	State	Dates Attended	Approx Credit Hours

What Award/Degree did you receive at your previous college?
Certificate
Associate Degree
Masters Degree
Does Not Apply
Diploma
Bachelors Degree
Doctoral Degree

Why did you choose to enroll at MCC?

Disabilities, if any (optional)

Students with disabilities should, as early as possible, contact the Associate Dean of Developmental Services at (641) 752-7106, or toll-free in Iowa at 1-866-MCC-IS-IT, ext 237, to request assistance and coordination of accommodations.

MCC offers joint admission with selected four-year institutions. If you plan to continue your education after MCC, to what college/university will you transfer?

MCC Activities Interest Indicator (Check one or more):

Baseball	Basketball	Cheerleading	Dramatics
Golf	Instrumental Music	Soccer	Softball
Student Activities Council	Student Senate	Vocal Music	Volleyball

I hereby certify that the information given in this
Name Date

Certification Verification: Type the words "I Certify" in the box at right to confirm:

Educational Equity Policy Statement

It is the policy of the Iowa Valley Community College District to provide equal educational and employment opportunities without discriminating on the basis of race, religion, color, creed, marital status, national origin, age, disability, sexual orientation, or gender, in its educational programs, activities or its employment and personnel policies.

The institution shall provide program activities, a curriculum and instructional resources which will reflect the racial and cultural diversity present in the United States and the variety of careers, roles, and lifestyles open to both men and women in our society. The curriculum, programs, and services shall foster respect and appreciation for the cultural diversity found in our country and an awareness of the rights, duties, and responsibilities of each individual as a member of a pluralistic society.

It is the policy of the Iowa Valley Community College District to affirmatively recruit women and men, members of diverse racial/ethnic groups, and persons with disabilities for job categories where they are under represented. A fair and supportive environment will be provided for all students and employees regardless of their race, religion, color, creed, marital status, national origin, age, disability, sexual orientation or gender. Harassment of a sexual nature or with demeaning intent related to any legally protected characteristic, made from one employee to another, from an employee to a student or vice versa, and from one student to another is a violation of this policy.

Employees or applicants who feel that they have been discriminated against may file a formal complaint through the District Complaint Procedure. Grievance forms may be obtained from the Director of Human Resources, the Dean of the College at either Ellsworth or Marshalltown Community College or the Iowa Valley Continuing Education administrative office.

Inquiries or grievances related to this policy may be directed to: Equity Officer, Iowa Valley Community College District, 3702 S. Center Street, Marshalltown, IA 50158, (641) 752-4643, ext. 5523; the Director of the Iowa Civil Rights Commission in Des Moines (515) 281-4121; the Director of the Region VII Office of the United States Equal Employment Opportunity Commission; or the Director of the Region VII Office of Civil Rights, United States Department in Kansas City, Missouri (816) 880-4200.

Federal	State
Title VI – 1964 Civil Rights Act (Race and National Origin)	Section 256 Iowa Code- Nondiscrimination/School Boards Age Discrimination Act of 1975 Integration of students on the basis of race, national origin
Title IX of the 1972 Educational Amendments (Gender)	Chapter 19B.11 – Equal Employment Opportunity and Affirmative Action
Section 504 of the 1973 Vocational/Rehabilitation Act and American Disabilities Act of 1990 (Disability)	Chapter 280 Iowa Code – services to limited English proficient students
Age Discrimination Act of 1975

If your application was sent correctly, you will receive an email from Admissions. If you do not receive a confirmation email within one week, please contact Admissions at (641) 752-7106 or toll free in Iowa 866-MCC-IS-IT.

3700 S. Center Street, Marshalltown, IA 50158 • Ph: 1-866-MCC-IS-IT • E: mccinfo@iavalley.edu