Biotechnology Boot Camp Registration Form

Student information

First name *This question is required.

Last name *This question is required.

Email address *This question is required. This question requires a valid email address.

Cell Phone

Student birthdate *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Street address *This question is required. Do NOT use P.O. Box or you will be charged Non-Md Resident Fee

City *This question is required.

State *This question is required.

ZIP *This question is required.

College ID Number (if known)

RaceChoose all that apply (Disclosure not mandatory by Montgomery College, but is required by the U.S. Dpeartment of Education)

Please list here *This question is required.

Check all that applyThese questions pertain to Maryland residents as defined in the Montgomery College Catalog. Maryland residents who are 60+ years of age or older are eligible for a student discount for courses designated "Tuition Waiver Applies" TWA. Maryland National Guard members may be eligible for a tuition discount, but must submit proof of enlistment for 24 month period from the adjutant general's office.

I have been a Maryland Resident for at least three months.
I am 60 years of age or older and a Maryland Resident.
I am a Maryland National Guard member.

By typing my full name below, I authorize the release of addresses, grades and attendance reports to my sponsor or employer (for third party tuition), and I certify that this information is correct and complete, and I agree to abide by the policies and procedures of Montgomery College. *This question is required.