Admissions Reservation Form

Contact Information

First Name: Last Name: Student ID Number (See Acceptance Packet): Enter your full address:

Street address
Apt No./ Floor	PO BOX:
City
State		Zip code
Country

Home phone number: (Enter mobile number if you do not have a home phone.) Cell phone number: Your E-mail address:

Check one response below:

I plan on, or am still considering, attending MVCC for the semester. Please keep my application active.
I have changed my plans and wish to have my acceptance extended for the: of year
I have changed my plans and will not attend MVCC. Please withdraw my application. If withdrawing, please indicate reason:

On-campus housing

I do I do not wish to be considered for on-campus housing. Do you want to identify as a student with a disability? Yes No

(If you indicate yes, this information will only be used to provide you additional information about services offered at MVCC)

By submitting this form, I confirm the information that I have provided on this form 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.

Initial Date