Malcolm X College of Chicago

Malcolm X College Online Admissions form

As your first step towards enrollment at Malcolm X College, please complete the Admissions application below and click submit. Your information will be forwarded to an Enrollment One-Stop Center at Malcolm X College and they will contact you.
Note: Admission to the Nursing and Health Science program require separate applications. Contact the Enrollment One-Stop Center to receive a Healthcare Profession Application.

I am applying for:			Year:
Last Four Social Security Number Digits
Birth Date
Sex:		Male Female
Last Name:
First Name:
Middle Initial:
Former Name:

Phone:
Email:
Street Address:
City:
County:
State:
Zip:
Country:
Province:
Ethnic:
When did you last attend this college? This is my first registration at any of the City Colleges of Chicago. This is my first registration at this college. I attended this college last term. I formerly attended this college in :(year)
Are You a US citizen Yes No	Permanent Resident Yes No	In US on Visa Yes No	(I-20)? Student Visa applyed for Yes No
What country were you born in?
What type of VISA
Employment Status 1-Full time -over 30 hours weekly 2-Part time - over 15 hours weekly 3-Part time - 15 hours or less weekly 4-Homemaker 6-Other
Are you going to apply for Financial Aid? Yes No
Family Income: 00-Less than $6,000 01-$6,000-$8,999 02-$9,000-$11,999 03-$12,000-$14,999 04-$15,000-$17,999 05-$18,000-$20,999 6-$21,000-$23,9990 7-$24,000-$26,999 08-$27,000-$30,000 09-Over $30,000
Is English your native language? Yes No
Are you a Veteran of the U.S. armed forces? Yes ? No
Are you currently serving on active military duty?Yes No
How did you hear about the City Colleges of Chicago?
High School or G.E.D. Information Name of last high school attended: Name City: State: Country: Province: Complete the information that best describes your high school status I graduated from high school on . . Date I passed the G.E.D. test on . . . Date I am still attending high school and will graduate on . Date I am not a high school graduate and have not received the G.E.D.
Other Colleges and Universities you have attended (begin with the most recent). (School Name) City State Country Degree Received? Yes No (School Name) City State Country Degree Received? Yes No
Intent/Goal: To prepare for transfer to a 4-year college To prepare for G.E.D. test To improve present job skills To pursue personal interests To prepare for future job immediately Unknown/Other
Academic Objective: 1-To take one or several courses 2-To obtain a Certificate 3-To obtain an Associate Degree What do you plan to major in? When do you plan to graduate?