MGCCC: Information Request Form

Admissions

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Programs of Study

The College

Athletics

Locations

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)