Special Student Application

 
 
Last name
First name
Middle initial  Maiden
Social Security Number   Date of Birth
Street address
Address (cont.)
City
State
Zip
Home Phone
Work Phone
Cell Phone

 
E-mail

 

I plan to enroll in the following courses:
*I am aware of, and have met the prerequisites for the above-mentioned course(s).

Please note: If prerequisite coursework is required before enrolling in the above-mentioned course(s), official documentation will need to be submitted for review prior to admission to confirm successful completion of any prerequisite coursework, OR the student will need to obtain the signature of approval from the professor teaching the accelerated course and the Dean of the Mount Mercy College Institute.

 

 I certify that the information on this application is correct and complete to the best of my knowledge. 

This application is not valid if information is withheld or if misinformation is given. Credit earned through an invalid application may be cancelled.

Students who are interested in taking one or two courses at Mount Mercy College are categorized as special students.

If the student currently is pursuing a degree at another college, it is recommended that permission be obtained from the home college before enrolling at Mount Mercy College. This completed form may be faxed to 319-365-7977 or mailed to the Mount Mercy College Institute 1330 Elmhurst Drive NE Cedar Rapids, IA 52402.

Students applying to Mount Mercy College as "special" status are not eligible for any federal or state financial aid.

 


Revised: October 13, 2006