AUTO COLLISION TECHNOLOGY

AUTO COLLISION TECHNOLOGY
Metropolitan Community College
Collision Engineering Student Application
MCC has many different options for students that are interested in the Auto Collision industry. Please consult an MCC instructor or our Automotive Outreach Specialist if you have any questions about which program would be the best fit. The Collision Engineering program is a 21-month option that involves a paid internship every other quarter in combination with classes at the Automotive Training Center.
CONTACT INFORMATION
Name

First NameLast Name
Middle
Home Phone
Cell Phone
Other Phone
Email Address
example@example.com
Preferred Method of Contact

EmailPhone
Current Street Address
P.O. Box / Apartment #
City
State
Zip Code
PERSONAL INFORMATION
Date of Birth

MonthDayYear
Date
Current Age
Gender

MaleFemale
Are you legally authorized to work in the US?No If Yes, please answer the following. If no, continue to Academic Information.

YesNo
Are you Currently Employed? If yes please answer the following. If no, continue to Academic Information.

YesNo
Name of Employer
Number of Hours worked weekly
Hours/Days Typically Scheduled
Type of Work
ACADEMIC INFORMATION
Current School District
Last HS attended
Are you currently attending?

YesNo
Expected Graduation Date

MonthDayYear
Date
Highest grade attended/completed
GED Completion Date

MonthDayYear
Date
Do you have any disabilities that require special accommodations?

YesNo
If yes, please provide details
What are your career goals?
What makes you a good candidate for this program?
Please describe your previous automobile related work experience.
The AUTB Cohort program requires students to interview with local industry partners with whom you will work while going to school. Are you willing to interview with select industry partners prior to being accepted in the program?

YesNo
MCC's AUTB Collision program sets a 100% attendance standard for all students including attending classes 4 days a week. Is there anything to prevent you from meeting this standard?

YesNo
If yes, please explain
PARENT/GUARDIAN INFORMATION IF YOUNGER THAN 19 YEARS OLD
Name of Parent/Guardian(s)
Phone Number
Home Address
Relationship to You
EMERGENCY CONTACT. If same as above, check here

If different, fill in the below information.
Name of Individual
Phone Number
Relationship to You
I certify the information on this application is correct and complete. I understand if I have not provided accurate information or the required materials, I may be denied acceptance in the AUTB Cohort program. If selected for the program. I agree to abide by the Metropolitan Community College Student Conduct Code. as well as all policies and procedures of the AUTB Cohort program outlined in the student handbook.
Applicant Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian Signature Required if applicant is younger than 19 years old
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Metropolitan Community College does not discriminate on the basis of race. color. national origin. genetic information. religion. sex, sexual orientation, gender identity, transgender status, marital status, age. pregnancy, disability, current or prior military service, protected veteran status or membership in any other class that is protected under local. state or federal law or regulation in admission or access to its programs and activities or in its treatment or hiring of employees.
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AUTO COLLISION TECHNOLOGY

Collision Engineering Student Application

CONTACT INFORMATION

PERSONAL INFORMATION

ACADEMIC INFORMATION