Adult Program Application

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Name*
First Last
Other Names Used
First Last
Date of Birth*
Month
Day
Year
Citizenship Status*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Cell Phone*
Home Phone
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
Relationship*
How did you hear about us?*
- Billboard
- Word of Mouth
- Social Media
- News Ad
- Postcard
Education
Indicate your current or highest completed education level*
High School Graduated From*
Graduation Year*
Enrollment Details
Preferred Enrollment Status*
- Full Time
- Mornings
- Afternoons
Select your Program*
*Cosmetology applicants must select Full-Time Status* **LPN will need to use the Application on the LPN Page**
Please Specify*
Please Specify*
Please Specify*
Please Specify*
Please Specify*
How will you pay for your tuition?*
- Tribal
- WIA
- Post 9/11 GI Bill®
- GI Bill®
- DRS
- Self Pay (by semester)
- Pell Grant
- Other Means
Other means of payment
Reasonable Accommodations
- I will need accommodations made for a disability.
- I have a condition that requires medication on a regular basis.
- I understand that accommodations are available to me, but at this time I exercise my right to not request them. If they are needed in the future, I understand that I can contact the Student Services Department to develop an accommodation plan.
Upon acceptance, adult students must disclose and provide documentation, such as official diagnoses; test results; physician’s statements, etc to a Career Advisor. Upon receipt, a Career Advisor will initiate a 504 meeting to determine appropriate accommodations. MDTC does not discriminate based upon on the basis of race, color, national origin, sex, pregnancy, gender, gender expression or identity, religion, veteran status, sexual orientation, disability, age, or genetic information in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.
Please reference Mid-Del Public School's Board policy J-42 - Medical Marijuana Policy for Students and regulation E1-R1 - Medication Administering to Students for more information. They can be located at https://meeting.assemblemeetings.com/Public/Organization/585.
Photo Release
Untitled*
- I hereby grant MDTC permission to use my photograph and name in all video or other digital media and in any and all of its publications, including web-based publications.
Credentialing
Several occupations require certifications or licensure which may be denied if a felony record exists. In addition, all employment and most internships require a background check. The main purpose of attending MDTC is to prepare you for gainful employment, so it is important that this barrier does not stand in your way. If there is any reason that you know a background check would inhibit your ability to be gainfully employed, please explain below.
Have you ever been convicted of, or plead guilty to a felony?*
- Yes
- No
MDTC reserves the right to access state records to obtain information.
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Adult Information Request
Full Time Programs
Personal Enrichment
Fast Track: Career Development Programs
Admissions (Financial Aid)

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1621 Maple Dr

Midwest City, OK 73110

(405) 739-1707

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Adult Program Application

Questions before applying?

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Education

Enrollment Details

Reasonable Accommodations

Photo Release

Credentialing