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PCCS Registration Form
Legal First Name:
Legal Last Name:
Middle Name:
Address:
City:
State
/
Zip:
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Cell Phone:
Home Phone (enter your cell number if you do not have a home phone number):
Age:
Birth Date:
High School:
Graduation Month
/
Year:
01
02
03
04
05
06
07
08
09
10
11
12
2025
2026
2027
2028
2029
2030
2031
2032
High School Email:
Personal Email:
Legal Sex:
Male
Female
Ethnicity and Race:
Ethnicity:
Non-Hispanic/Latino
Hispanic/Latino
Please select any or all you identify with:
American Indian or Alaskan Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Choose not to respond
Which program are you requesting:
Automotive Technology (full year program)
Early Childhood Education (Spring semester only)
EMS/Criminal Justice (Fall or Spring semester)
EMS/Fire Science (Fall or Spring semester)
Heating, Ventilation, and Air Conditioning (full year program)
Manufacturing and Advanced Technologies (full year program)
Nursing Assistant (Fall or Spring semester)
For Criminal Justice, Fire Science, or Nursing Assistant, indicate your preferred semester:
Fall
Spring
Terms and Conditions:
• Course prerequisites must be satisfied as identified in the McHenry County College Catalog.
• MCC may adhere to a selection process when the demand for a class is greater than the seats available. A priority system will be established to rank students using the following criteria:
• Senior status
• Date of Application Submission
• High School Recommendation
• I am responsible for providing a copy of my high school transcript or home school academic record if requested.
• I understand that when I enroll at MCC, the courses and grades will remain on my official college transcript.
• If I desire high school credit in addition to college credit, I understand it is my responsibility to contact my school directly.
• By signing this form, I give permission for MCC to disclose information related to my enrollment and progress at MCC to my parents and high school officials.
By checking this box, I acknowledge that I have read and understand the terms and conditions listed above.
Student Signature (printing my name serves as my e-signature):
Date:
Parent/Guardian Signature (printing my name serves as my e-signature):
Date:
Parent/Guardian Email:
Submit