Dual Credit Application for Admission

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

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 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

May we text?

MC corresponds important information through email, please provide an address that is checked frequently.

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):

My high school is?

I will graduate from high school on:

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)

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

Custom Questions

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 Records within five business days of submission of my Apply Texas application.

Are you a Single Parent? Are you either unmarried or divorced with custody of a child under the age of 18 (including if you are currently pregnant)?

Are you 17-24 years old and have a parent on full-time active duty in the U.S. Military?

Please answer YES if you are 17-24 years old and:

* Homeless

* Sharing a house or apartment with more than one family

* Living in a hotel, car, campground, shelter, or RV

* Living somewhere that is not considered housing

Please answer yes if any of the following apply:

* Are you a homemaker trying to re-enter the workforce?

* Are you unemployed?

* Are you employed less than full-time or at a job that does not provide enough wages to support you and your family?

* Have you recently been terminated or laid off?

* Were you self-employed and now reentering the workforce due to economic challenges?

Are you a parent or guardian of a child younger than 18 years of age?

Candidacy Information

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

Contact 1

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

Contact 2

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

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