Mohawk Valley Community College Application for Admission  
     
   

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Section 1. Identifying Information

Social Security Number:
  (No Dashes)  
Current Legal Name:            
     
(Last Name)   (Jr/Sr/III)   (First Name)   (Middle Name)
Preferred first Name if different than that listed above:
Former name: Do you have any educational records under a different or former name? If yes, please list:
     
(Last Name)   (Jr/Sr/III)   (First Name)   (Middle Name)
Section 2. Address Information

Please indicate your permanent home address:
Street
City State Zip Code
Mailing Address (if different than home address):
Home phone # Other phone #
E-mail address (If you do not have an email address please indicate "None")
New York State Residents only, list your New York county of residence:
How long have you lived in New York State? (years / months) /
Section 3. Personal Information

All Applicants must answer the following questions:
Gender: male or female Date of Birth: (MM/DD/YYYY)  
Are you the first person in your immediate family to attend college? Yes or No
Are you a U.S. veteran ? Yes No If yes, do you plan to seek V.A. Education Benefits? Yes No
Have you ever been convicted of a felony? Yes or No
  If "Yes," are you currently on probation or parole? Yes or No
     
   

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Please help us to recognize the diversity of our applicant population by answering the following questions.
Are you Hispanic/Latino? Yes or No
If Hispanic/Latino, what is your Hispanic/Latino origin (select only one):
Central American Dominican Mexican Puerto Rican South American Other Hispanic/Latino
All applicants, please indicate your race (select one or more choices):
American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
                   
Section 4. Citizenship Information

Are you currently a United States Citizen?  Yes or No
If "No", fill in the rest of this section.
  How long have you lived in the Unites States? (years/months) /
  How long have you lived in New York State? (years/months) /
If not a United States Citizen,
  Are you permanent resident of the United States? Yes or No
If you are a permanent resident, list your Alien Registration Number: A
Native Language:  Country of Birth:
Country of Citizenship: Current Visa Type
Country Issuing Visa: Visa Issue date: Visa Expiration Date:
      (MM/DD/YYYY)   (MM/DD/YYYY)
Section 5. High School Education

Prior to my enrollment at MVCC (check one):
1. I have graduated or will graduate from an accredited high school (mo/yr) /
2. I have completed or will complete a home school or a non-registered school diploma (mo/yr) /
3. I have graduated from a high school in a foreign country (mo/yr) /
  3A. I can provide an English translation of my educational records from my home country 
  3B. I have no educational records from my home country and will not be able to provide them
4. I have received or will receive a high school equivalency diploma (GED) (mo/yr) /
  State that issued the GED:
5. I will not have a high school diploma or GED prior to the date I want to start at MVCC.
   
School Name
Street Address
City State Zip Code or Postal Code
Type of High School Diploma (choose one):
1. N.Y. State H.S. Diploma Type: Advance Regents Regents Honors Regents Standard Local IEP Diploma
  If you have indicated that you will be receiving an IEP Diploma, contact the MVCC Admissions Office for further instructions.
2. Out of State Diploma Type: College Prep Local IEP Diploma Correspondence
       
   

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Section 6. College Education (for high school students and transfers with earned college credit)

Have you ever been dismissed from a college for any other than academic reasons? Yes or No 
  If "Yes", indicate the school name here:
List the college you most recently attended first, then others. Include any MVCC attendance:
  College Name(s) State Dates Attended Credits earned Degree (if any)
to
to
to
to
To evaluate transfer credit, MVCC requires an official transcript from each college where the credit was originally earned.
Section 7. MVCC Enrollment Information

Indicate entry term and year: (choose one)
  Fall (August) Spring (January) Summer (May/July)
  Entry Year:
Student type (choose only one from the list):
  (A) First time in college, no college credits completed prior to enrollment
  (B) First time in college with earned college credits during high school
  (C) Completed MVCC credits within the past year, but after high school graduation
  (R) Completed MVCC credits more than a year ago, but after high school graduation
  (T) No MVCC credits completed after high school, transferring after attending one or more colleges
Expected course load: Full-time (12 credits or more) or Part-time (less than 12 credits)
Housing or commuter preference (choose one):
  (R) I will commute from home and/or take online courses from home.
  (H) I would like to considered for On-Campus Residence Hall Housing (available on the Utica Campus only).
Please Note: To be considered for On-Campus Residence Hall housing, you must meet one of the initial academic eligibility requirements which are as follows. See www.mvcc.edu/housing for details
  • Minimum cumulative high school average of 70 at time of Admissions application
 
  • GED minimum score of 2400 or
 
  • Completion of 12 credit hours with a minimum 1.7 cumulative GPA from MVCC or another accredited institution
Prior to attending MVCC, I have completed or will have completed:
  an LPN license
  EMT Certification
  a Certificate in Medical Radiography
  an FAA License in Airframe & Powerplant Mechanics
  Graduation from the Utica Fire Academy
       
   

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Major requested:
 
For the major you listed above, do you wish to complete a (choose one): degree or certificate
Campus preference (choose one): Utica Campus Rome Campus or Online
Intercollegiate athletic interest:
Men's sports: Baseball (07) Women's sports: Basketball (23)
  Basketball (03)   Bowling (28)
  Bowling (11)   Cross Country (25)
  Cross Country (02)   Golf (29)
  Golf (10)   Indoor Track (26)
  Ice Hockey (06)   Lacrosse (40)
  Indoor Track (05)   Soccer (22)
  Lacrosse (12)   Softball (24)
  Soccer (01)   Tennis (20)
  Tennis (09)   Track and Field (27)
  Track and Field (08)   Volleyball (21)
Section 8. Services to Students with Disabilities

The MVCC Disability Services Office coordinates and provides services to students with disabilities, including but not limited to individuals who are blind, deaf, learning disabled, mobility impared, those with health-related impairments such as epilepsy, diabetes, or Chron's disease, and those with mental health disabilities. In order to receive necessary accommodations and services in a timely matter, individuals with disabilities are encouraged to contact the Disability Services Office as early as possible in the application process. The goal of the Disability Office is to help ensure that individuals with disibilities have an equal opportunity to participate, complete, and succeed at MVCC. Please contact them directly at:

Utica Campus, Academic Building, Room 153, (315) 792.5644
Rome Capus, Plumley Complex, Room A30, (315) 334.7744

Or by email at: disabilityoffice@mvcc.edu

The information that I have provided on this application is true to the best of my knowledge. I realize that any deliberate falsification or misrepresentation of information may result in either denial of admission or dismissal from the college.
         
I have read and agree to the above statement: YES  or NO
 
Please confirm identifying information
 
Social Security Number:
  (No Dashes)  
 
Applications are not considered complete and ready for acceptance decision until original copies of all supporting documents (transcripts, etc.) are received by Admissions. Upon receipt, all submitted documents become the property of the College.
 
If you have questions, please call (315) 792.5354
Mohawk Valley Community College is an Equal Opportunity Educational Institution.
 
The Personal Privacy Protection Law requires that this notice be posted when collecting personal information from individuals. The information on this application will be used in the processing of your application for admission to the college. Failure to provide the requested information may delay the processing of your application. The authority to request this information is found in Section 355(2)(i) of the Education Law.