Dual Credit @ MVC

MVC Dual Credit Application

Personal Info
                
                Last Name*
                
                First Name*
                
                Middle Name
                
                Birthdate* (mm/dd/yyyy)
                
                Primary Email*
                
            Select Your High School* 
             
                Gender* 
                
                US Citizenship Status*
                 
Citizenship Country*
Birth Country*

Primary Address

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Phone Number*

Guardian Information
                Guardian's Last Name*
                
                Guardian's First Name*
                
                Address Line 1*
                
                Address Line 2
                
                City*
                
                State*
                
                Zip Code*
                
                Phone Number*
                
                Primary Email
                
                    Guardian Agreement
                
                    This portion of this online form is to be completed by your legal Guardian:
                    I Understand my child/dependent has applied for participating in course work in
                        order to receive college credit at the price of $80.00 per credit hour including
                        any other applicable fees. I consent to the sharing of my student's academic and
                        financial records with school officials and acknowledge that I am responsible for
                        payment to his/her account. I agree to the terms and conditions of policies and
                        procedures set forth by Missouri Valley College.
                    
                    Completing the following section is required by the Guardian and will act as his/her
                        legal signature, agreeing to the statement above
                    
                    Guardian Full Name:*
                
                    Last 4 of Guardian's SSN:*

Ethnic Background

Ethnic background information is requested for Federal, State and Institutional reporting purposes only. Your choice to respond is greatly appreciated but, it is optional

Please select your Race from the following options (you can make more than one selection (if applicable)) AFRICAN AMERICAN NATIVE AMERICAN / ALASKA NATIVE ASIAN HAWAIIAN/PACIFIC ISLANDER HISPANIC/LATINO WHITE

By signing your name below you certify that all information given on the application is complete and accurate to the best of your knowledge. You understand that the undergraduate catalog and student handbook contain all pertinent information regarding Missouri Valley College's policies and procedures. You understand that you have a continuing responsibility to keep MVC informed of information relevant to our application. The electronic submission of this form constitutes your official signature as stipulated by Missouri Valley College and the State of Missouri.

*Applicant's signature and Date fields must be filled in order to submit your application.

Applicant's Signature (type full name)*

Date*

MVC Dual Credit Application

Personal Info

Primary Address

Guardian Information

This portion of this online form is to be completed by your legal Guardian:

Completing the following section is required by the Guardian and will act as his/her legal signature, agreeing to the statement above

Ethnic Background

Ethnic background information is requested for Federal, State and Institutional reporting purposes only. Your choice to respond is greatly appreciated but, it is optional

*Applicant's signature and Date fields must be filled in order to submit your application.