Youth Programs Scholarship Application Form

MC's SAT / ACT Registration Form

Student Contact Information

Student First Name *This question is required.

Student Last Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

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

calendar

School student is currently attending *This question is required.

What Grade? *This question is required.

1. Parent / Guardian Contact Information:

Parent/Guardian's First Name *This question is required.

Parent/Guardian's Last Name *This question is required.

Parent/Guardian Email Address *This question is required. This question requires a valid email address.

Mobile Phone Number *This question is required.

Home Phone

Please provide one of the following documents to provide verification of your financial eligibility:
· Copy of Free and Reduced Lunch form OR
· Copy of last year's tax form (please remove social security numbers)

UPLOAD FILES HERE

College ID Number (if known)

Student 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.

Are you a Maryland resident? *This question is required.These questions pertain to Maryland residents as defined in the Montgomery College Catalog.

I have been a Maryland Resident for at least three months.
I have NOT lived in Maryland Resident for at least three months.

2. Class Information (Course Title / Start Date / Class ID#) *This question is required.

Course Title
Start Date
Class ID#

Permission Form for Parent/Guardian:

By typing my full name below, and I certify that this information is correct and complete, and I agree to abide by the policies and procedures of Montgomery College.
I understand that my child will be attending classes on an open college campus and there will be no student supervision
provided outside the classroom. He/she will abide by the rules and regulation of Montgomery College, including
exhibiting classroom behavior that allows for a study environment free from harassment, discrimination, and disruption.
Behavior contrary to this will not be tolerated and may result in expulsion.
Should a medical emergency occur, I grant authority to Montgomery College Campus Security staff to provide
necessary and reasonable medical attention to my child.

*This question is required.

Youth Programs Scholarship Application Form - New

MC's SAT / ACT Registration Form