Application for Re-Enrollment After Academic Dismissal

Complete this Request for the Office of the Registrar

MCC Student ID#:

Submission Date:

Birth date:

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Name:

Program of Study:

Students who wish to provide documentation with this application can submit these documents to the Office of the Registrar.

1. Please provide a statement and/or documentation related to circumstance(s) contributing to the first academic dismissal:
2. Please provide a statement and/or documentation related to circumstance(s) contributing to additional academic dismissal(s):
3. Please provide a statement related to academic resources used (I.e. Tutor Center, Math Center, Writing Center, Counseling, etc.) while attending MCC previously:
4. Please provide a statement related to the status of any previous circumstance(s) (if applicable) and/or steps taken to prevent these circumstances and/or future circumstances that would prevent your academic success:
5. Please provide any additional comments that you would like the review board to consider while reviewing you application:

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