Mountain Empire Community College

Application For Admission

Prefix Ms.

First Name Carey

Middle Name Mitch

Last Name Cantrell

Suffix

SSN 051762002

Former First Name

Former Middle Name

Former Last Name

Date of Birth 3/7/1979

College Mountain Empire Community

College

Campus Main

Class Type CRED

Term 2018 Spring between

01/10/2018 and 05/08/2018

Plan Management (212)

Previous Student or Employee N

Emplid 7361917

Primary Phone 347-321-8923

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Street Address 1 3738

Street Address 2 My Drive

City New York

State NY

Postal Code 10011

Country United States

Current Residence NEW YORK

Have you lived in Virginia the past twelve N

months?

Where have you lived? NEW YORK

Email Infe1969@teleworm.us

Student's Employer (If Employed)

Business Phone 347-321-8923

Emergency Contact First Name Mark

Emergency Contact Last Name Davis

Emergency Contact Relationship Other

Emergency Contact Phone 347-351-8514

Ethnicity

Gender Male

English is Primary Language Y

Military Status No Military Service

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Citizenship Status Native

Level of high school education Home School (graduated or

currently enrolled)

Home School State Virginia

Home School Graduation Date Jun 1998

College Foreign College

Attended From Aug 1998

Attended To Apr 2002

Degree Type No degree earned

Were you suspended or dismissed from the last N

college attended?

Father's Highest Education Do Not Know

Mother's Highest Education Do Not Know

Are you a U.S. citizen? Yes

What is your military status? Have never served in the U.S.

military

Whose domicile do you want to use to claim My own domicile

eligibility?

Have you lived in Virginia for the last twelve No

months?

Have you worked in Virginia for the past twelve No

months and paid Virginia income taxes on at
least $14,500 of earned income?

For the last twelve months, have you held a No

Virginia driver's license or Virginia DMV ID?

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For the last twelve months, have you held a No
driver's license or DMV ID in any other state?

For the last twelve months, have you owned or No

operated a motor vehicle registered in Virginia?

For the last twelve months, have you owned or No

operated a motor vehicle registered in any other
state?

For the last twelve months, have you been No

registered to vote in Virginia?

For the last twelve months, have you been Yes

registered to vote in any other state?

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 Application Confirmation

Name Carey Mitch Cantrell

Date Submitted 04/23/2018

Emplid 7361917

Username cmc24806

Tuition Information Based on the residency

information you supplied, you
will receive out-of-state tuition
rates.

Assigned Plan Management (212)

Advisor Fran Doyle

Advisor Phone 276/523-2400

Advisor Email fdoyle@mecc.edu

Administrative Contact Admissions Office

Phone 276-523-7474

Admissions Website http://www.me.vccs.edu/

contact.htm

Notice All new curricular students,

including previous dual
enrollment students must meet
with an academic advisor.

Notice We are currently reviewing your

application for in-state tuition
purposes and will notify you
once the review is complete.
You will be unable to enroll
for classes until you receive

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 notification from Enrollment
Services.

The signature of a parent or guardian is required for applicants under the age of
18.

Parent/guardian signature: ________________________________________

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