Meridian Community College
910 Highway 19 N,
Meridian, MS 39307
601-483-8241
1-800-MCC-THE-1

Information Request

Please send me information on the following:
Name:
Address:
City:
State:
Zip Code:
Birthdate:

MM
/
DD
/
YYYY
Email:
Cell Phone:

###
-
###
-
####
Phone:

###
-
###
-
####
Last High School Attended:
Graduation Date:

MM
/
DD
/
YYYY
GED Completion Date:

MM
/
DD
/
YYYY
GED Location:
No Degree or GED:
 Check if you have Neither High School Degree nor GED 
Attended College Previously?
 Yes 
 No 
Other Information Needed: