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New Student Application

* Required

Casual Student Application for Admission

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

Continue with this Application only if all of these statements are true:

* Enrolling at MC for personal Interest only and not seeking a certificate/degree at any institution of higher education

* Not intending to receive a certificate/degree from Midland College

* Requesting waiver from Texas Success initiative (TSI)

* Limited to a maximum of two courses per semester (academically restricted courses are not eligible for enrollment).

* Classified with a major of Casual Student/No Degree, this major is not eligible to receive financial aid

Enter Legal Name

Do not use nicknames, abbreviations or diacritical marks (accents or tildes)

Legal Last Name

Legal First Name

Legal Middle Name

Suffix

Preferred Name

Birth Date

Social Security Number (SSN)

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 the Records Office 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 the Records Office 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 the Records Office 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 the Records Office at records@midland.edu as this could affect your tuition.

Core Residency Questionnaire

Texas Higher Education Coordinating Board rule 21.25 requires each student applying to enroll at an institution to respond to a set of core residency questions for the purpose of determining the student's eligibility for classification as a resident.

PART A: Previous Enrollment

During the 12 months prior to the term for which you are applying, did you attend a public college or university in Texas in the Fall or Spring term?

Which Texas public institution did you last attend? (Give full name, not just initials)

In which term where you last enrolled?

During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident (out-of-state) tuition?

If you paid resident (in-state) tuition at your last institution, was it because you were classified as a resident (in-state) or because you were a nonresident (out-of-state) who received a waiver?

Part B: Residency Claim

Are you a resident of Texas?

If you are a resident of another state in the U.S., please choose from the list.

If you are a resident of a foreign country, please choose from the list.

Part C: Texas Residency

Did you live, or will you have lived, in Texas the 36 months leading up to high school graduation or completion of your GED?

When you begin the semester for which you are applying, will you have lived in Texas for the previous 12 months?

Directory Information Release

If I do not want my directory information released to third parties, I must submit the Request to Withhold Directory Information Form to the Midland College Office of Student.

I Understand

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?

Provide your current/mailing address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Phone Number

Cell Phone

May we text?

MC corresponds important information through email, please provide an address that you check frequently.

Email Address

Confirm Email Address

Parent Education Level

Parent 1 Education Level

Parent 2 Education Level

Race Information

Are you Hispanic or Latinx (regardless of race)?

Code	Description
-1	Yes
-2	No
-3	Unreported

Please select the racial category or categories with which you most closely identify. Check as many as apply.

Code	Description
-5	White
-4	Native Hawaiian or Other Pacific Islander
-3	Black or African American
-2	Asian
-1	American Indian or Alaska Native

Gender

Gender

Female
Male
Prefer to not answer

Foster Care/Texas Conservatorship

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

Would you like to receive information about possible financial or other assistance for students who have been in foster care?

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

As a non-degree casual student according to TSI definitions. I understand and acknowledge:

* I am requesting a waiver from Texas Success Initiative (TSI).

* I do not intend to receive a certificate/degree from Midland College

* I am limited to a maximum of two courses per semester that are not academically restricted courses.

* I am enrolling in courses for personal interest only and I am not seeking a certificate/degree at ANY institution of higher education

* I will be classified as casual student/no degree as my major and I will not be eligible to receive financial aid

* I am not eligible for this waiver if I am dual credit/early admissions student

*I must inform Midland College should I decide to enroll as a degree seeking student who plans to receive a certificate/degree from Midland College and will comply with all requirements of Midland College and TSI rules adopted by the Texas Higher Education Coordination Board. (Chapter 4, subchapter C, Rule 4.54 10b)

I Acknowledge and Agree to the terms of this form.