Adult Student Enrollment Form

Your Details & Contact Information
Maiden name, formerly known as, etc.

You must enter at least one phone number.


Enrollment Details

Select your Choice of Major

Arts, A/V, and Communication
Graphic Communications

Business Information Technology
Business Office

Medical Office

Construction and Manufacturing
Construction Trades




Human Services

Health Careers

Early Care & Education

Information Technology
Cyber Security Professional


Automotive Services

Automotive Collision

Reasonable Accommodations
Adult students identified as having a disability must have proper documentation on file in order to receive accommodations.
Photo Release

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.

MDTC reserves the right to access state records to obtain information.

The following information is voluntary and for reporting purposes only in accordance with the 1968 Civil Rights Act, as amended.

Check all that apply