Montgomery Community College :: WDC Form

WDC Form

WDC Registration

Legal Name*
Date*
Date Format: MM slash DD slash YYYY
Social Security Number
Date of Birth*
Date Format: MM slash DD slash YYYY
Sex
- Male
- Female
Race
- White
- Black
- Hispanic
- Indian
- Asian
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Home Phone
Cell Phone
Education
Tell us your highest level completed
Last High School Attended
Please include state and year
Employment*
- Full-Time
- Part-Time
- Unemployed-Seeking
- Unemployed-Not Seeking
- Retired
Complete if an active volunteer or paid member of EMS, DOC, DPS, Law Enforcement, or Fire Department:
Agency Affiliation
Job Title
My signature attests that I am actively affiliated with the public safety agency listed and I hold the job classification indicated. Furthermore, I agree to allow my employer to access my academic record.
Class Info*
Class Title / Number Class Prefix Start Date Term Fee
HRD Tuition and Fee Waiver – Verification Statement
The State Board of Community Colleges grants permission to waive tuition and fees for enrollment in classes coded as Human Resources Development if the individual meets one of four criteria listed below. Individuals not signing this form must pay the applicable fee to register for a Continuing Education course.
I qualify for a tuition and fee waiver under the following criteria:
- I am currently unemployed
- I have received notification of a pending layoff
- I am working and eligible for the Federal Earned Income Tax Credit
- I am working and earning wages at or below two hundred percent (200%) of the federal poverty guidelines.
By signing you verify that you meet one or more of the criteria for fee waiver.
Signature*
Check Here if you DO NOT wish MCC to use your photo and/or name in its publicity, marketing, promotion, and advertising efforts as well as in editorial [i.e. brochures, catalog, news releases, academic standing (honors, awards, scholarships) features, etc.
- I DO NOT
Colleague ID
For MCC use only

Class Title / Number	Class Prefix	Start Date	Term	Fee

WDC Form

WDC Registration

Complete if an active volunteer or paid member of EMS, DOC, DPS, Law Enforcement, or Fire Department:

My signature attests that I am actively affiliated with the public safety agency listed and I hold the job classification indicated. Furthermore, I agree to allow my employer to access my academic record.

HRD Tuition and Fee Waiver – Verification Statement