Request Information about MCC

Complete the form below to request information about Mott Community College (MCC).
Fields with a red asterisk (*) are required.
We will respond to your inquiry via email as soon as possible.

~ Note: this form is NOT the application for admission. ~

Your Personal Information

Legal First Name

Middle Name

Legal Last Name

Suffix

Preferred Name
(If different than your Legal Name.)

Date of Birth *
MM/DD/YYYY

Your Contact Information

Enter your personal email address below; do NOT use a High School or College email address.

Email Address *

Confirm Email Address *

Enter your phone number(s) below using the following formatting:

US, Canada, Bermuda, & Caribbean: XXX-XXX-XXXX
All others: +XX XX XXX XXXX

Mobile/Cell Phone

Would you like to allow Mott to send you text/SMS updates & notifications?Do Not AllowAllow

Home Phone (If different than Mobile/Cell Phone.)

What is your preferred method of contact?

Your Address

Is your address OUTSIDE of the U.S. or Canada? *

YesNo

Street Address (Line 1) *

Street Address (Line 2) (Optional)

City

State/Province *

ZIP/Postal Code

Country

Your High School Information

High School Graduation Status *

Additional Information

How did you hear about Mott Community College?

Have you applied to the Michigan Reconnect program? *
To learn about the Michigan Reconnect program, click HERE.

YesNo

What information would you like about Mott?

The semester I would like to begin my studies is:

I would like more information about: *
For any topics not listed, select Other.

My academic program of interest is: *
Not sure? Check out our academic programs HERE.

"Other" / Question(s) / Additional Information:
If you selected Other, you have a specific question(s), or you would like to provide us with more detail about your inquiry, please enter it here: