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* 1. Last Name

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* 2. First Name

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* 3. MDCC ID#:

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* 4. Cell Phone #:

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* 5. MDCC Student Email or Personal Email Address:

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* 6. Have you ever earned any college credit?
Check all that apply.

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* 7. Have you declared a major?

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* 8. Do you plan to transfer to a 4-year college after your time at MDCC?

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* 9. Are you a dorm or commuter student?

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* 10. Will you have a job while you are a student at MDCC?

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* 11. I have a career goal for myself in the next five+ years.

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* 12. I know what I want to accomplish my first year at MDCC.

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* 13. I have some definite academic strengths.

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* 14. I have some definite academic weaknesses.

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* 15. I plan to participate in extracurricular activities like sports, band, student government, clubs, etc.

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* 16. Feel free to list any other possible challenges to your success at MDCC, such as these:
--family obligations
--financial concerns
--transportation difficulties
--etc.

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