Direct Credit Form

Direct Credit Registration Form

This form is to be completed and submitted to MCC prior to the start of the class(es).
Student Name*

First NameMiddle NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email*
example@example.com
Student Phone Number*
Please enter a valid phone number.
Student Date of Birth*

MonthDayYear
MCC Student ID Number*
Your MCC student number is emailed to you after you are accepted. If you do not have a student number, please do not complete this form until you do.
Current Grade Level*
Expected Graduation Year*
Tech Center (to be billed)*
Who is your counselor at Whitehall High School?

Carrie GoodrichDerek Westerlund
Tech Center Direct Credit Coordinator Email
example@example.com
Parent/Guardian Name*

First NameLast Name
YOUR PARENT/GUARDIAN'S EMAIL ADDRESS CANNOT BE THE SAME AS YOUR EMAIL ADDRESS.
Parent/Guardian Email*
example@example.com
Student Release Authorization

I certify that all the answers on this application are complete and accurate to the best of my knowledge. I understand that falsifying any part of this application may result in cancellation of admission and/or registration. I agree to become knowledgeable about MCC’s rules and regulations and abide by them. I understand that course transferability varies by institution, and that it is therefore my responsibility to check with the receiving institution to see if my credits will transfer. MCC may release my academic records to my school as listed below, including but not limited to: course progress, attendance, and final course grade(s). I understand that I am responsible for ALL tuition and charges related to attending MCC if a course is not approved by the school district.

Please sign and date below if you agree.
Student Signature*

Clear
Today's Date

MonthDayYear
Direct Credit Coordinator Information
Semester*
Academic Year*
Please use the full 4 digit year (i.e. 2024).
Direct Credit Coordinator - Please check ALL that apply to the applicant:*

Direct Credit- I authorize this student to enroll in named Muskegon Community College course(s).Payment-I hereby authorize payment for enrollment in named Muskegon Community College course(s).Grade- I authorize that final grade reports should be sent to myself.
Direct Credit Course(s) Requested Please be sure to include the class & section number for each class (for example, BUS 131 DCNW62)*
Please be sure to include the class & section number for each class (for example, BUS 131 DCNW62)
Direct Credit Coordinator Signature*

Clear
Parent/Guardian Portion
Parent/Guardian Information and Release

I understand that my child intends to enroll in a college course. I understand that my student will be required to meet all attendance and classroom participation requirements expected of a college student. My student and I agree to become familiar with college policies covering course withdrawal, tuition refunds, class attendance and campus standards of conduct outlined in the MCC catalog. I understand that information regarding my child's course progress, attendance, and final grade(s) will be shared with the principal or counselor of his or her school upon the school’s request in accordance with the Family Educational Rights and Privacy Act Regulations (FERPA).
Parent/Guardian Signature

Clear
Should be Empty:

Direct Credit Registration Form

Direct Credit Coordinator Information

Parent/Guardian Portion