Dual Credit Application for Admission

Non-discrimination statement: https://www.midland.edu/about/public-info/non-discrimination-statement.php

Financial Aid Displacement Advisory

Personal Information

Enter your full legal, last, first, and middle name. Do not use nicknames or abbreviations.  Use your full legal name on all documents sent to MC.  Please do not include diacritical marks such as accents or tildes.

Last Name

First Name

Middle Name

Suffix

Preferred Name

Birth Date

Place of Birth

Social Security Number

Citizenship Information

Are you a U.S. Citizen?

Of what Country are you a Citizen?

Do you hold Permanent Residence status (valid I-551) for the U.S.?

Please provide your Resident Number

Date Permanent Resident card issued

Please submit a copy of both sides of the card to records at records@midland.edu 

Do you have an application for permanent residence (Form I-485) pending with the U.S. Citizenship and Immigration Services (USCIS)?

Submit a copy of your Notice of Action from the USCIS form I-797C to records at records@midland.edu as this could affect your tuition.

If you have an individual Taxpayer Identification Number (ITIN) and do not have a Social Security Number filled in above, please enter it below. Otherwise please leave this blank.

Did you live or will you have lived in Texas for 36 consecutive months leading up to High School graduation or completion of the GED?

Please submit a completed Affidavit of Intent to Become a Permanent Resident to records at records@midland.edu as this could affect your tuition.

Are you a foreign national here with a visa that makes you eligible to domicile for Texas residence purposes or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status?

Indicate which visa type applies:

Please submit a copy of your Notice of Action from the USCIS form I-797C or a copy of your current Visa to records at records@midland.edu as this could affect your tuition.

Citizen Status

Please provide your Permanent Address

Address Line 1

Address Line 2

City

State

County

Zip Code

Country

Are you currently living or receiving mail at a different address?

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Phone Number

Cell Phone

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If you can't get to the link on the privacy policy it is here Midland College Website Privacy Information

MC corresponds important information through email, please provide an address that is checked frequently (Please do not use High School email address). 

Email Address

Confirm Email Address

High School Information

Please select the option that best describes you:

For the next academic year, what grade will you be in?

My reason for attending Midland College is (choose one of the following):

Partner High School

High School Student ID

Expected High School Graduation Date:

Select the last day of the month and year you expect to graduate.

Candidacy Type

Dual Credit

First Generation College Student

Mother’s Education Level

Father’s Education Level

Race Information

Are you Hispanic or Latinx (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, (regardless of race)

Racial Category:
Select all that apply.

Gender

Gender

Foster Care/Texas Conservatorship

At any time in your life, were you placed in foster care or adopted from foster care in Texas?

Military Service member, Veteran, or Dependent

A US military service-member is a person who is serving in any branch of the US Armed Forces, including the National Guard or Reserves. 

I am a Veteran (former US military service member)

I am a Current US military service member

I am the Spouse or dependent of a veteran or a current US military service member

I am the Spouse or dependent of, or a veteran or current US military service member with an injury or illness resulting from military service (service-connected injury/illness)

I am the Spouse or dependent of a deceased US service member

Candidacy Information

What made you choose Midland College?

What year do you plan to begin your studies?

What term do you plan to begin your studies?

Select your area of study/interest?

Certificate or Degree?

Select your major

Emergency Contacts

By providing this information, you are giving Midland College permission to advise your contact that you have applied to participate in the Midland College Dual Credit Program.

Emergency / Parent / Guardian Contact 1

First Name

Last Name

Phone Number

Email Address

I give Midland College permission to discuss my education record (grades, advising, etc.) with Contact 1.

Address

City

State

Zip Code

Emergency / Parent / Guardian Contact 2

First Name

Last Name

Phone Number

Email Address

Address

City

State

Zip Code

Please do not navigate away from this page until you see the Submission confirmation message. It may take up to 2 minutes.