Adult Student Enrollment Form

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

You must enter at least one phone number.



Education




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


Plumbing

Welding

HVAC

Human Services
Cosmetology


Health Careers




Early Care & Education



Information Technology
Cyber Security Professional

Transportation
Aviation

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
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.


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

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


Check all that apply