Inquiry Form

1
Name* This field is required.
First Name
Last Name
2
Contact Information* This field is required.
Email
Phone Number
Mobile
Non-Mobile
Phone Type
Email
Phone - Text
Phone - Call
Preferred Method of Contact
3
Texting NumberTexting is a great way to keep in touch! If you'd like to receive texts from Mid, enter your mobile phone number below. If not, keep this question blank and click "NEXT."
4
Can we text you?
YESNO
5
Opt-in to texts?
6
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Which best describes you?* This field is required.
First Time in Any College After High School Graduation
I Will Transfer Credits from Another College
Currently Enrolled in College Elsewhere and Would Like to Also Take Classes at Mid (Guest Student)
I've Taken Classes at Mid Michigan College Before (When Not Dual Enrolled)
I'm in High School and Would Like to Take College Classes
I would like to take classes that aren't for credit, like short-term licensure courses or personal interest
8
Student Type (abbreviated)
9
Today's Date
Date
Year
Month
Day
10
Date of Birth* This field is required.
Year
Month
Day
11
What semester would you begin?* This field is required.
Fall 2022
Fall 2023
Winter 2023
Winter 2024
Summer 2023
Summer 2024
12
Which location / campus would you like to primarily attend?* This field is required.
13
Campus Preference (Abbreviated)
14
Assigned Recruiter
15
Age
16
Student Type
17
Entry Term
18
Specific question for us? Ask away. If not, just click "Next."
Huge
Large
Normal
Small
Ok
Ok
19
Thank you! We've got the info we need to be in touch. But we'd like to learn more about you so that we can personalize our response. Would you like to answer a few more questions?* This field is required.
YESNO
20
Do you intend to transfer your credits from Mid to another college/university some day?
YESNO
21
Are you a veteran or military service member?
YESNO
22
What are you interested in learning more about?Please select all that apply.
Education Benefits / Grants
Educational Plans / Goals
Campus Resources
Student Vet Organizations
Study Skills
Volunteer Opportunities
Employment / Resume
VA Healthcare / Healthcare
VA Housing / Home Loans
Community Support
Clothing Resources
Housing Resources
Veteran Services
Dependent Benefits / Support
Food Assistance
23
Are you interested in visiting one of our campuses?
YESNO
24
High School / GED InformationWhich describes best how you completed your high school education
Graduated from a Michigan High School
Graduated from Home Schooling
Graduated from a non-Michigan High School
Earned a GED
Did not complete High School
25
High School
26
Year of High School Graduation
27
Would you like to have someone determine how many credits you already have through prior schooling or work / life / military experience?
YESNO
28
Would you like information about a particular program of study or offering?
YESNO
29
What pathway group or educational offering is of greatest interest to you?Please select only one.
Transfer Programs - Arts & Communications Focused
Transfer Programs - Math & Science Focused
Business and Technology Programs
Health Sciences Programs
Human Services Programs
Skilled Trades
Non-Credit / Short Term License Options
Personal Interest Offerings
30
Pathway of Interest
31
Are there other pathway groups or offerings you're interested in?
YESNO
32
Please indicate all pathway groups or offerings in which you are interested.Please select all that apply
Transfer Programs - Arts & Communications Focused
Transfer Programs - Math & Science Focused
Business and Technology Programs
Health Sciences Programs
Human Services Programs
Skilled Trades
Non-Credit / Short Term License Options
Personal Interest Offerings
33
What specific pathway/program interests you most?
34
Are you interested in other programs?
YESNO
35
Please indicate all programs in which you are interested.Select all that apply
Accounting
Administrative Assistant Professional
Advanced Integrated Manufacturing
Automotive Technology
Biology Transfer
Business
Business Studies Transfer
CADD - Computer Aided Drafting and Design
CDL - Commertial Driver's Licence
Chemistry Transfer
CNA - Certified Nurse's Aide
Community Health Worker
Computer Information Systems
Criminal Justice
Criminal Justice Transfer
Drone Training
Early Childhood Education
Electrical Apprenticeship
Elementary Education Transfer
Graphic Design
History and Political Science Transfer
HRA/HVAC - Facilities, Heating, Refrigeration, and Air Conditioning
Math Transfer
Medical Assistant
Medical Imaging (including CT, MRI, EEG, and Radiography)
Michigan Transfer Agreement
Nursing
Pharmacy Technician
Phlebotomy
Physical Therapist Assistant
Physics Transfer
Psychology Transfer
Public Health
Secondary Education Transfer
Sociology Transfer
Visual Arts Transfer
Web Design
Welding
36
Would you like to speak with someone about your funding options?
YESNO
37
Referral Page URL
38
Form Page URL
39
40
We got it! Now it's time to click SUBMIT 😊

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Admissions at (989) 386-6661 or admissions@midmich.edu.

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.
41
Tags
Todo
In Progress
Done
Should be Empty: