Date of Submission:

Mid-Plains Community College
Student Application for Admission

Transforming lives through exceptional learning opportunities for individual student success

Please complete all sections and then make sure to click the SUBMIT button on the final page to complete the application process. This may take a few moments, we recommend that you do not close out your browser until you see a confirmation of your submitted application that includes additional information for next steps.

If you have any questions on the application please contact Admissions:  308-535-3783 or admissions@mpcc.edu

Current Legal Name

This is your name as it appears on your Social Security Card, Immigration documents, and/or Passport. Your legal name will appear on your official MPCC records: admissions records, athletic eligibility, Federal Financial Aid, transcript/grade reports, and student account statements.

First Name

Middle Name

Last Name

Suffix

Last Name at Birth

Campus Name

MPCC recognizes that students may prefer to use a name other than their legal name to identify themselves, regardless if you have legally changed your name. MPCC reserves the right to reject inappropriate requests, such as offensive or derogatory language. Your campus name will appear on the following MPCC records: CampusWeb, Canvas, Class/Grade lists, commencement program, email, Dean's or President's list, and Campus Card.

First Name

Middle Name

Last Name

Legal, Home Permanent Address

Is your legal home address in the United States?

Address Line 1

Address Line 2

City

State

Zip Code

County

Country

Address Line 1

Address Line 2
Municipality, state, or province, and postal code

Country

What is your city of birth?

Phone Contact Information

Mobile Phone

Alternate Phone

Personal Email Address

Please provide a personal email address such as gmail, hotmail, yahoo, etc. Please note that high school email addresses are typically deleted after graduation.

Personal Email

Biograph Information

Social Security Number
Format: 000-00-0000

Your social security number is required for claiming education related costs on your IRS forms. If you do not have a social security number, please enter 000-00-0000.

Date of Birth
Month/Day/Year (MM/DD/YYYY)

Sex at Birth

Personal Pronouns

Gender Identity

If available options do not include your gender identity or personal pronouns and you wish to self-disclose, please select Options Do Not Apply and type your information here.

Citizenship Status

Country of Citizenship

Citizenship Status

Click Here To Learn More About the I-20 and Studying in the States

Are you required to have a student Visa and/or I-20 form to study in the United States?

Ethnicity and Race

Are you Hispanic or Latino?

Race - choose one or more

Residency

In-State - US Citizen or Green Card holder who has lived in NE for 180 days prior to enrollment
Out-of-state - any Citizen (US, Non-US, Green Card, or Non-Green Card) who does not live in NE and does not qualify for LB239
Border State - US Citizen or Green Card holder who is a resident of Colorado, Kansas, South Dakota, or Wyoming

Residency

I am a resident of the following state:

I have been a resident of this state since:
*MM/DD/YYYY

Education

Are you or did you attend high school in the United States? (this includes home school, online home schooling, and GED students)

In which state are you currently attending or did you graduate from high school/home school?

Which high school did you graduate from?

Was your high school listed?

Are you working on or have you completed your GED?

When will you or when did you complete your GED?
MM/DD/YYYY
If you are unsure of the day of the month, select the first day of the month.

Please enter your high school name, city, and state here, or enter "Home school" if home schooled

Non-United States High School

What year will you (or did you) graduate High School?

Have you attended or are you attending classes at a college other than Mid-Plains Community College? (Do not list MPCC below)
Mid-Plains Community College includes:
- McCook Community College
- North Platte Community College
- Community campuses in Broken Bow, Imperial, Ogallala, and Valentine

Which state was the college located?

Which college did you attend?

Was your college listed?

Please enter the college name, city, and state here:

Do you need to add an additional institution?

Which state was the college located?

Which college did you attend?

Was your college listed?

Please enter the college name, city, and state here:

Do you need to add an additional institution?

Which state was the college located?

Which college did you attend?

Was your college listed?

Please enter the college name, city, and state here:

Do you need to add an additional institution?

If you have any additional colleges to report, please email the list to admissions@mpcc.edu.

Reporting Data

What is the highest level of education either of your parents, guardians, or primary caregivers have obtained?

Please choose yes if the following statements apply to you:

I am a single parent - 

English is NOT my Primary Language - 

I am a Homemaker seeking Career Skills - 

Please select any of the following that apply to you:

I am currently employed:

Which of these statements best describes how you feel about attending college?

Including yourself, how many people are in your family?

My household income level is

If you have been diagnosed with a physical or mental impairment that limits your ability to participate in the educational experience offered by MPCC AND you wish to self-disclose, please indicate below.

Military

Are you or a family member affiliated with the United States armed forces?

Are you a Veteran?

Which branch of military service?

Are you an Active Duty service member?

Which branch of military service?

Are you a member of the National Guard?

Are you a member of the Reserves?

Are you a Veteran/Active Duty member or Spouse/Dependent of a Veteran/Active Duty member who has suffered a service related injury/illness?

Are you a spouse or dependent of a Veteran who is deceased?

Are you a spouse or dependent of Veteran/Active Duty service member?

Enrollment Year and Term

I plan to begin in the year

I plan to begin in the term

I plan to be enrolled

Type of Student

Are you a current high school student?

When do you plan to take classes with MPCC?

I plan to attend classes

Please select which best describes you:

Degree
- I am planning to pursue a degree, diploma, or certificate at Mid-Plains Community College.
OR
- I plan to take courses at Mid-Plains Community College that I will transfer to another institution.

Non-Degree
- I am taking classes for fun, for special interests, or other reasons and do not expect to earn a degree, diploma, or certificate.
OR
- I am taking classes at Mid-Plains Community College while attending another institution. (I am a visiting student.)
OR
- I am wanting to enroll in a CNA or Med Aide course

Map Program Code

I am currently a

Not 15 years Old?

If you are under 15, your application/registration will be reviewed by Administration to determine if registration may be allowed for your special situation.

When submitting your registration form please also submit a high school transcript and any test scores. There is an upload link at the end of this application or have your school email them to admissions@mpcc.edu.

Non-Degree Seeking Candidate Application

Non-Degree (Enrichment)
- I am taking classes for fun, for special interests, or other reasons and do not expect to earn a degree, diploma, or certificate.

Non-Degree (Visiting)
- I am taking classes at Mid-Plains Community College while attending another institution. (I am a visiting student.)

Program of Interest

Degree Seeking Candidate Application

Will you be requesting financial aid?

Are you planning to live on-campus?

Identify the degree you plan to receive

Academic Transfer Program/Associate | Associate of Applied Science

Certificate | Diploma

What type of degree do you want to earn?

Program of Interest

International Student Application

This application must be returned six months prior to anticipated enrollment date, along with the following:

1. If your country's primary language is not English we will need a copy of your Test of English as a Foreign Language scores (TOEFL). An absolute minimum score of 61 for the internet-based test is required for admissions. International students who provide proof of having completed 24 semester hours or equivalent of coursework at a college in the US are not required to provide proof of English language proficiency for admission to MPCC. International students applying to MPCC who have graduated from a US high school which they attended for a minimum of one academic year are not required to provide proof of English language proficiency for admissions to MPCC.
2. If you have taken an SAT or ACT please provide a copy of your scores to admissions@mpcc.edu. These are not a required test, however, they will be used for placement into appropriate English and Mathematics courses.
3. Please provide your Original/Official high school transcripts or equivalent academic record with a certified English translation if these records are not originally in English. Official transcripts must have your graduation date or date of completion on it, and must include a School Official Signature or School Stamp for certification. If you are currently still in high school and have not received your final high school transcript, you may provide a letter from your school officials on Letterhead stating your current status and expected graduation date. This does not replace the Official Transcript requirement, and MPCC can deny admissions and registration if the transcripts are not received prior to the start of your first semester.
4. Please provide Original/Official college transcripts (if applicable) with a certified English translation.
5. Please provide current (within three months), written notification from a bank (translated into American dollars) as evidence of your ability to maintain yourself financially while attending MPCC. This can be in the form of a Bank Statement or letter from your bank on Bank Letterhead. Please contact admissions@mpcc.edu for the current bank statement amount. If receiving an academic or athletic scholarship, the bank statement amount will be pro-rated.
6. If a sponsor is funding your education, an affidavit of support is required, as well as a current (within three months) copy of your sponsor's bank statement verifying the required Bank Statement amount (see Requirement 5) in sponsor's name for a calendar year.
7. Please contact admissions@mpcc.edu for the current deposit requirement amount in US dollars. This deposit is due prior to issuance of the I-20 to cover tuition and fees (based on 15 credit hours), room and board, housing deposit, and books for one semester. Any unused portion will be applied to the following semester of attendance or refunded upon program completion. If you are denied a visa or decide not to attend Mid-Plains Community College, $100 will be withheld for processing charges and the remaining amount will be refunded. If receiving an athletic or academic scholarship, deposits will be pro-rated.
8. Written verification from an American or International insurance company that the applicant is covered for physician's care, hospitalization, and major medical costs while in the US is required prior to issuance of the I-20 and must be kept current each successive year at MPCC. In addition to a copy of the policy, a statement in English from the Insurance Company issuing the policy verifying dates and extent of coverage is required.

I agree to the International Requirements:

Please Read Before Submitting

By pressing the submit button on this page

- I certify that all the information on this application is complete, true and accurate.
- I agree to abide by the policies and regulations of MPCC.
- I understand that any information given falsely or withheld may make me ineligible for admission.
- I also agree to pay all tuition, fees and charges.
- By providing my contact information I agree to let MPCC communicate with me via phone, email, mail, or text.  To opt out of communication I can contact admissions@mpcc.edu.

Electronic Communication Consent

Before using electronic means (i.e. email) to communicate with you regarding financial matters, you must affirmatively consent to the use of an electronic record. This does not mean that MPCC will only send information electronically, but this consent allows us to communicate with you electronically as needed. By agreeing below, you are agreeing to the following:

1. I consent to participate in electronic transactions for all financial information provided or made available to myself and for all notices and authorizations.
2. I authorize MPCC to electronically credit my financial aid funds to my student account for tuition, fees, books, on campus housing & meals, and other educational costs.

I acknowledge that I have the right to cancel or modify my authorization, in writing, at any time and that changes will be effective the date MPCC receives my notification and are not retroactive.

Do you consent to electronic communication (e.g. Financial Aid and Student Account information)?

*Please note, by declining electronic communication consent you may experience delayed processing times related to Financial Aid and Student Accounts.

Unofficial Transcripts / Test Score Upload

Some courses require placement scores in order to enroll. If you have a copy of any unofficial transcripts or test scores, and would like to provide them now, please upload them here.

Please note - only 1 document per upload button.

Files must be in .docx, .doc, .pdf, .png, .jpg, or .tif extentions.

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Please do not close your browser until you receive the Successful Submission screen
after clicking Submit - this may take a few moments.

MPCC ADA Statement

If you have a disability and require an accommodation while attending Mid-Plains Community College, please contact: Robin Rankin, North Platte Community College North Campus, 308-535-3637 or 800-658-4308 extension 3637, rankinr@mpcc.edu; Chris Turner, North Platte Community College South Campus, 308-535-3715 or 800-658-4308 extension 3715, turnerc@mpcc.edu; or Dillon Hargrove, McCook Community College, 308-345-8128 or 800-658-4348 extension 8128 hargroved@mpcc.edu; or disabilityservices@mpcc.edu.