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					                                              Registrar’s Office

                                  Declare an Academic Major Form

Please Print (in CAPS) all the information on this Form.                                 Date: _______________


Please check if you are applying for Financial Aid or Veterans Benefits

In order to process you request, we must have on file:

        1. Your high school transcript or a copy of your original high school diploma.
        2. Documentation of two (2) measles and one (1) rubella inoculation.



MCC Banner/Student ID: @___________________________ Social Security #:__________________________

Name: ______________________________________________________________________________________

Daytime Phone #: ______________________________ Evening Phone #: _______________________________

Name of Major Declared: ______________________________ A.S. Degree  A.A. Degree  Certificate

Student Signature: ______________________________________ Date: ________________________________




                                        REGISTRAR OFFICE USE ONLY


Date Student Record was Updated: ______________________________________________________________

High School Transcripts:                    Yes        No

Immunizations:                              Yes        No




Office of Registrar – DAM (Rev. 11/03/05)

				
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