Download Course Units Where Taken When Taken Grade

1. Last Name: ______________________ First Name: _________________________ Previous Name(s) if any ________________
**Gender
Male **Ethnicity
-NonFilipino
________
**For statistical purposes only
If you do not have a Moorpark College Student ID # please submit an application to the college.
MC Student ID#: _________________________ S.S.N._________________________ **Date of Birth ________________________
Address __________________________ City ___________________________ State: ___________ Zip Code ________________
Daytime Telephone No. ______________Evening/Cell No.________________ [email protected]
All Veterans and spouses must attach a copy of form DD-214.
Veterans Eligibility: active military, naval, or air service and discharged under conditions other than dishonorable.
Includes full-time duty in the National Guard.
2. High School Graduation Date____________________________________ or GED ______________________________________
Name of High School _____________________________________Highest Degree held _________________________________
3. List COMPLETED PREREQUISITE coursework required for application: (all must be completed with a letter grade of “C”
or better).
Course
Units
Where Taken
When Taken
Grade
ENGL M01A OR ENGL M01AH English Composition, 4 units
MATH M03 Intermediate Algebra or higher, 5 units
BIOL M01 OR BIOL M16 OR BIOL M02A OR BIOL M02AH, 3 – 5
units
4. Required Documents: Include with application:
 ALL Official College Transcripts (in original sealed/unopened envelope), including VCCCD (VC, MC, OC)
(all courses taken for credit and no credit must be included even if not part of the major)
 Official Advanced Placement (AP) scores from College Board
 ALL course descriptions from the college catalog for above prerequisite courses taken outside of VCCCD
**Admission dependant on clearance of Background Check and Drug Screen**
I understand official sealed transcripts must be submitted with application. I authorize the use of this information to evaluate my
qualifications. By signing this application I certify under penalty of perjury that the information on this application is complete and
correct. I understand that falsification or failure to report may result in my dismissal. Incomplete application materials will result in
your application not being considered, and all materials will be discarded. APPLICATION WILL NOT BE ACCEPTED IF NOT SIGNED AND
DATED BY APPLICANT
Print Name: ________________________________Student Signature: _____________________________________Date: _____________________
To be completed by Counselor after submission
Overall GPA: _______  Official Transcripts (in original sealed/unopened) envelope.  Course descriptions from all courses
taken outside of VCCCD (prerequisites only)
Counselor Signature: ___________________________________________________ Date: ________________________________________________
Updated 03/29/17 crw