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Student Reactivation Form

If you have not been enrolled at Montgomery College as a credit student in the last four years, you are required to complete this form in order to be eligible for registration. If you have any other outstanding registration blocks, those must resolved as well before you will be able to register for a course. This form allows us to collect the most current contact, address and curriculum information for you as you return to the College.


Name                        

Student ID           M-

Previous Name       

Birth Date (MM/DD/YYYY)    

SSN (last four digits)                     * * * - * * -

Curriculum Title     

Curriculum Code    

Note: Changes to name, Social Security Number [SSN] and/or gender, require legal proof of the action in order to update. Proof includes driver’s license, social security card, legal court documents, and/or intent of gender change (doctor's letter). This documentation must be submitted to the Office of Admissions and Records at your primary campus of attendance.


Address/Declaration of Permanent Domicile for Tuition Purposes

Note: Students with temporary visas, including B(tourist), F(student) and J(exchange visitor) are not eligible for in-county or in-state tuition based on residency. Other non-U.S. Citizens must show proof of immigration status (e.g. employment authorization or passport), or be charged the out-of-state tuition and fees rate. For information about in-county or in-state tuition, call (240) 567-5000 or visit the Office of Admissions and Records at your primary campus of attendance.

Address    

City            

State          

Zip Code 

How long have you lived at your current address?    years    months

Home Phone    

Work Phone   

Cell Phone      

Email              


Citizenship

If Other than U.S., Current Immigration Status (I-94) 


Do you (or your parents) own or rent your primary residence?

If yes, located in   County,    State


Do you file income taxes?

 If yes, filed to   County,    State


Are you registered to vote?

If yes, registered in   County,     State 


Do you have a valid driver’s license?

If yes,    State


Do you own a motor vehicle?

If yes, registered in   State


Student Confirmation

By clicking the Submit button, I certify that the information on this form is correct and complete. I understand that falsification may result in dismissal and/or retroactive adjustment of tuition and fees. Upon request by a designated College official, I agree to provide additional evidence of the above facts for verification by the College.

 

 


Montgomery College

Montgomery County, MD

240-567-5000

©2014, Montgomery College