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Success Scholar Program Confirmation
Welcome to the Success Scholars Program. Please complete the form below to get started.
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* Indicates required question
To be eligible for the Success Scholars Program please check off all the identities that apply to you.
*
African American/Black
Asian/Asian American
Latinx
LGBTQ+
Undocumented/DACA
Other:
Required
First Name
*
Your answer
Last Name
*
Your answer
Pronouns (optional)
Your answer
Student ID (A#)
Your answer
How many classes are you currently registered for?
*
1+
I'm not registered.
I don't know.
I need help with registering for classes.
MCC Email
Your answer
Personal Email
Your answer
Cellphone Number
*
Your answer
Would you like a Success Scholars Mentor?
*
Yes, I want a mentor!
No, thank you.
Thank you for confirming your participation in the Success Scholar Program. We will contact you on a regular basis to inform you of our workshops and activities. If you have any questions, please submit them here or email
SuccessScholars@middlesex.mass.edu
.
Your answer
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