APPLICATION FOR ADMISSION RETURN TO: State if U.S.A. or Country Month Date Year

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1 M P C Monterey Peninsula College APPLICATION FOR ADMISSION RETURN TO: MPC Admissions and Records Office 980 Fremont Street Monterey, CA NOTE: YOU MUST COMPLETE ALL ITEMS ON BOTH SIDES OF THIS FORM FALL 20 SPRING 20 SUMMER 20 SOCIAL SECURITY/ I.D. NUMBER - - Must Be Accurate PLACE OF BIRTH BIRTHDATE - - State if U.S.A. or Country Month Year GENDER Male Female LEGAL NAME LAST NAME: FIRST NAME: MIDDLE INITIAL: PREVIOUS NAME USED AT MPC: TELEPHONE #: ( ) MAILING ADDRESS OR P.O. BOX: STREET ADRESS: CITY AREA CODE STATE PHONE NUMBER ZIP CODE CITIZENSHIP STATUS U.S. CITIZEN: YES If not a U.S. citizen, indicate status below: NO (2) Permanent Resident Issued: (3) Temporary Resident Issued: (4) Amnesty (5) Refugee/Asylum (6) Student Visa (F-1 or M-1) (7) Other Status (Specify): PRIMARY LANGUAGE Is ENGLISH your primary spoken language? ETHNIC BACKGROUND (OPTIONAL) (10) White Non-Hispanic (21) Chinese (42) Central American (22) Japanese (43) South American (23) Korean (44) Other Hispanic (24) Laotian (50) American Indian, Alaskan (25) Cambodian (61) Guamanian (26) Vietnamese (62) Hawaiian (27) Indian Subcontinent (63) Samoan (28) Other Asian (64) Other Pacific Islander (30) Black Non-Hispanic (70) Filipino (41) Mexican (80) Other Non-White EDUCATIONAL GOAL at MPC (1) Personal Interest (not for employment) (2) Transfer to a four-year college with an Associate Degree (3) Transfer to a four-year college without an Associate Degree (4) Associate Degree, General Education (5) Associate Degree, Vocational (6) Vocational Certificate (7) Discover/formulate career interests, plans, goals (8) Job Skills - to prepare for a new job/career (9) Job Skills - to maintain or advance in current job/career (10) Maintain Certificate or license (e.g. Nursing, Real Estate) (11) Improve basic skills in English, reading, or math (12) Complete credits for high school diploma or GED (13) Undecided on goal YES NO ENROLLMENT STATUS (1) NEW (K-12 student never attended college) (2) NEW TRANSFER (attended college elsewhere) (3) RETURNING TRANSFER (attended MPC, then another college) (4) RETURNING (last college attended was MPC) of last attendance at MPC: SEMESTER Year (5) CONTINUING (attended MPC last session/semester) EDUCATIONAL STATUS NOT A HIGH SCHOOL GRADUATE: YEAR RECEIVED: (1) Over 18 not a graduate of and no longer enrolled in high school (2) High School Enrichment student currently enrolled in grade K-12 (3) Currently enrolled in Adult School HIGH SCHOOL GRADUATE, NO COLLEGE DEGREE: (4) Received a U. S. High School Diploma (5) Received a GED or Certificate of Equivalency/Completion (6) Received Certificate of High School Proficiency exam (7) Foreign High School Diploma/Certificate COLLEGE GRADUATE: (8) Received an Associate Degree (9) Received a Bachelor's Degree or higher HIGH SCHOOL LAST ATTENDED (Check One) Alisal Everett Alvarez Notre Dame Año Nuevo Pacific Grove Carmel Pacific Grove Adult Carmel Adult Palma Carmel Valley Robert Louis Stevenson Marina La Via Salinas Monterey Santa Catalina Monterey Adult Seaside North Salinas York Other High School: County: State (if U.S.A.): or Country: DATE OF GRADUATION OR LAST ATTENDANCE: Month: Year: COLLEGE MOST RECENTLY ATTENDED (to include MPC): City/State : Country : s: From to FOR OFFICE USE ONLY PROCESSED BY: TELEPHONE PRIORITY MAJOR Program of study you intend to pursue at this college: (See Major Code Sheet) INFORMATION RELEASE Can personal data and current enrollment info be released to transfer institutions without your written consent? YES NO HOURS WORKED Estimate average number of hours per week you will work during your planned semester of enrollment: VETERAN Check this box if you are a veteran of the U.S. Armed Forces: HIGH SCHOOL COLLEGE RESIDENCE RESIDENCE DATE

2 STATEMENT OF LEGAL RESIDENCE PART I - TO BE COMPLETED BY ALL STUDENTS For education purposes, California residency depends not only on presence in California for one year immediately preceding the opening of the semester or session, but also on acting toward establishing residence and intending to make California the home for other than a temporary purpose. The one-year residency period (proof required) which a student must meet to be classified as a resident does not begin to run until the student is both present in California and has manifested clear intent to become a California resident. The burden is on the student to demonstrate clearly both physical presence in California and intent to establish California residence. When did your present stay in California begin? Month: : Year: List states in which you lived for the last two years and the dates: State: State: From: To: From: To: Did you file California State Income Tax? NO YES Last Tax Year: Are you registered to vote? NO YES State: Month//Year registered: In the last year, did you attend an out-of-state college as a resident? NO YES State attended: In the last year, have you been the petitioner for a divorce in another state? NO YES State: Do you have a driver's license? NO YES State: Mo//Yr Issued: Do you have a California ID card? NO YES Mo//Yr Issued: Other proof of residency in California: PART II - TO BE COMPLETED ABOUT YOUR PARENT(S) OR LEGAL GUARDIAN(S) IF YOU ARE UNMARRIED AND UNDER 19 YEARS OF AGE I have lived continuously for the past two years with my parents(s) or legal guardian(s) and he/she/they have lived continuously for the past two years at a California address NO YES If 'YES,' Check one: Both Parents Mother Father Legal Guardian(s) Relationship: If 'NO,' give date that parent(s) or guardian(s) moved to CA: Month: Year: Did he/she file California State Income Tax? NO YES Most recent Tax Year: Is he/she registered to vote? NO YES State: Month//Year: Does he/she have a driver's license? NO YES State: Month//Year Issued: Does he/she have a California ID card? NO YES Month//Year Issued: Other proof of residency in California: PLEASE COMPLETE THE FOLLOWING ABOUT PARENT(S) OR LEGAL GUARDIAN(S): Names(s) of parent(s) or legal guardian(s): Address: City: State/Zip: In case of emergency, please indicate a contact name and phone number(s): Name: Phone number(s): PART III - TO BE COMPLETED BY ALL STUDENTS Are you an active duty member of the U.S. military? NO YES / Branch of service: Are you the spouse or dependent child of an active duty U.S. military person? NO YES / Branch of service: If 'YES' to any of the above, what is the state of legal residence on military records? If you are the dependent of an active duty member of the U.S. armed forces and wish to request exemption from nonresident tuition, you must complete the U.S. Military Dependent Resident Statement on the back of the Registration Form and obtain the required signature. PART IV - TO BE SIGNED BY ALL STUDENTS I declare under penalty of perjury that the statements submitted by me are true and correct. All materials submitted for admission become the property of Monterey Peninsula College. STUDENT'S SIGNATURE: DATE:

3 CONCURRENT ENROLLMENT FOR STUDENTS IN GRADES 6-12 Return to Admissions & Records Office Incomplete or illegible forms will not be processed GENERAL INFORMATION Monterey Peninsula College (MPC) allows students in grades 6-12 to enroll in advanced scholastic college courses numbered Students must submit an application and Concurrent Enrollment Form every semester/session they attend. Procedures to Enroll at Monterey Peninsula College 1. Complete an Application for Admission. Applications are online! If under 14, the student must complete a paper application. Once the application is submitted, the student will receive a Student ID. 2. Complete and submit a Concurrent Enrollment Form. Obtain all required signatures. Students in grades 6-8 must get approval from the Dean of Student Services. Call (831) to schedule an appointment with the Dean. 3. Complete Math and/or English Assessment Tests if planning on enrolling in math or English courses. Appointments can be made online through WebReg or by calling (831) Once authorization is granted, the student may register for the approved classes online through WebReg. Special Note to Parents Regarding Right to Access Student Records Under Section of the Education Code, parents of community college students do not have a right of access to their children s student records, regardless of whether the student is under the age of 18. In accordance with this regulation, a student s college record and transcript will only be released upon the student s request. PART A: TO BE COMPLETED BY STUDENT Name Fall Spring Summer Last First MI year Address City State Zip MPC Student ID # / / Phone ( ) Grade level (6-12) during term: Student has permission to register for the following course(s) ONLY: Department and Course Title Note: Concurrent Enrollment for 6-8th grade students will not be approved once classes begin. EMERGENCY CONTACT INFORMATION: Name: Last First MI Relationship: Contact #: PLEASE COMPLETE BOTH SIDES OF FORM A&R 7/ Fremont Street, Monterey, CA Approved by Phone (831) /4007 Fax (831)

4 PARENT / LEGAL GUARDIAN AND STUDENT ACKNOWLEDGEMENT It is imperative that parents/legal guardians and their minor children understand that, as students, they are entering a college environment that carries with it certain possible scenarios, not all of which can be anticipated. The average age of the Monterey Peninsula College student has increased and the student body has become increasingly diverse in all respects. The atmosphere of classes may frequently reflect this diverse adult population. Parent / legal guardian must acknowledge and initial the following: Student may only enroll in advanced scholastic courses numbered All college coursework and grades become a permanent part of the student s official college academic history and transcript. These grades will not be changed or erased. Poor grades can have a far reaching effect, future admission to college or university of choice, eligibility for financial aid, etc. Student must abide by the Monterey Peninsula College Standards of Conduct and are subject to the student disciplinary procedures as stated in the College catalog. All disciplinary incidents become a part of the student s personal history. Student is expected to meet all deadlines, classes must be dropped within the stated deadline in the Schedule of Classes, grade options selected, assignments turned in on time, etc. Attendance is required, but not monitored. No one will call if the student misses class. Instructors cannot inform parents when classes are canceled at the last minute or when the class ends prior to the appointed time. Instructors cannot sit with a child while he/she waits to be picked up. Courses may include frank discussions of sensitive topics. Audio-visual presentations may be graphic in their content. Student may be exposed to vulgar language outside of the classroom. Student may access pregnancy and HIV information and condoms through Student Health Services. Group work, field trips, and/or class presentations may be expected in the class. If required, these activities and assignments will not be modified to accommodate minors. If the instructor determines that the student is not keeping up with the class, the instructor has the right to drop the student. These precautions are not meant to create undue concern for parents or minor students, only to serve as an advisory to allow you to manage your particular situation so the minor will have a positive educational experience at Monterey Peninsula College. For additional information regarding unattended children on campus, please refer to MPC Board Policy I certify that I have read and understand the listed responsibilities and expectations mentioned on the back of this form for a minor attending Monterey Peninsula College and approve enrollment in the courses listed on the front of this form: Parent / Guardian Signature Student Signature PART B: TO BE COMPLETED BY PRINCIPAL OR SCHOOL DESIGNEE I approve the enrollment of this student into the courses specified on the other side of this form. If this is for the Summer Session, I verify that no more than 5% of this student s grade level has been recommended to enroll at MPC. Name of School (Home schools: attach a copy of Private School Affidavit) Address of School Name and Title of School Official Signature of School Official PART C: TO BE COMPLETED BY DEAN OF STUDENT SERVICES FOR STUDENTS IN GRADES 6-8 Approved Denied Signature of Dean of Student Services or Designee

5 ADD / DROP FORM This form is only accepted in instances where online registration is not possible. Students must bring this form in person to the Admissions & Records Office. Incomplete or illegible forms will not be processed. Name Registration Term: Last First MI Fall Spring Summer year MPC Student ID # / / Address Phone ( ) City State Zip 4-Digit Section Dept and Course Units P/NP or Letter Grade ADD Add Code Instructor s Name and Signature (if required for class registration) 4-Digit Section DROP Dept and Course NOTE: If adding after the published deadline, please use the Late Add Petition Student Signature A&R 9/ Fremont Street, Monterey, CA Approved by Phone (831) /4007 Fax (831)