Permian Basin Graduates -
You're Already In!

ChapConnect Acceptance Form

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Through Midland College’s ChapConnect program, you’ve been instantly admitted — no extra applications, no long waits. That’s right: if you’re a recent Permian Basin  graduate, you’re already accepted and can sign up for classes now.

You’ve worked hard to earn that high school diploma — don’t lose the momentum! Whether you're planning to earn a degree, train for a high-demand job, or explore your interests, Midland College has a path that fits your goals.

Your future is ready when you are.
Take the next step and claim your spot today!

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

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.

Citizen Status

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.

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?

Residency Determination

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

Translation

Translation

Race Information

Are you Hispanic or Latinx (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?

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

Student Type

What type of student are you?

High School Information

The high school I graduated from was?

Candidacy Type

Dual Credit

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.

Parenting:

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

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

Housing:

Please answer YES if you are:

* 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

Home Life:

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

Is English your Primary Language?

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?

What is your Plan?

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 Contact 1

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

Emergency Contact 2

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

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