Request Information

To better serve your request for information, we'd like to know a little more about you.  Please provide accurate information to ensure a quick response.

PERSONAL INFORMATION

First Name

Last Name

Social Security Number
(Required)

Date of Birth:

Address (Line 1)

Address (Line 2)

City

State

Zipcode

Phone

Email:

HIGH SCHOOL INFORMATION 

High School Last Attended

Date of Graduation

Date GED Obtained

Location

PREVIOUS COLLEGE/UNIVERSITY INFORMATION
List two most recent universities, colleges and career-technical institutions previously attended.

Name of Institution

City, State

From (Sem/Year)

To (Sem/Year)

Did you graduate?

 Yes
 No

Name of Institution

City, State

From (Sem/Year)

To (Sem/Year)

Did you graduate?

 Yes
 No

 

ACT score

Anticipated Major at MGCCC

Anticipated Enrollment Term

Anticipated Enrollment Year

 

 

Campus/Center of Interest

 Jackson County Campus
 Jefferson Davis Campus
 Perkinston Campus
 George County Center
 West Harrison Co. Center
 Advanced Manufacturing and Technology Center
 Keesler Center

 

 

Please Send the Following

 Application for Admission
 Financial Aid Information
 Housing Application
 Catalog
 Scholarship Information
 Schedule of classes
 Tuition & Fees Information

Other:

(Please Specify)

 


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