Admissions and Records Forms
Below are frequently used Admissions and Records forms. Should you have any questions regarding the use of a form, please contact the Office of Admissions and Records at: registration@mendocino.edu or 707-468-3101
How to File a Form:
- Download and save fillable forms to your device. Your data will not be saved if you complete the form in your web browser nor will you have access to the approved electronic signature option (when available)!
- Open the PDF file with either of these applications:
- Adobe Reader™, available for free
- Sign and date your form if required:
- "Wet" signature: Print, sign and date the form. Then scan it to PDF and submit by email or mail as noted in column 3 below.
- If the form has a fillable student signature field, create and apply an electronic signature, date and save the form.
- Close and reopen the saved file to ensure your changes are still there.
- Save a copy of your email and the completed form for your records.
- Email the saved form to the reviewer/approver as an attachment from your MC Gmail account.
If you are a continuing student, always email forms from your MC Gmail account to submit the form (see table column 3 below).
Note: Avoid entering personal information on public computers and/or wireless access points.
| FORM NAME | DESCRIPTION | HOW TO FILE |
|---|---|---|
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This exemption is available to certain nonresident students who meet a specific set of requirements. Please review the AB 540 exemption instructions (.pdf). File completed forms with Admissions and Records (see next column). Helpful: California Residency for CSU Tuition Purposes |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
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| Students that have received a substandard grade (D, F, NP) may request a forgiveness of the grade points associated with the grade or repeat the course for a better grade and request an adjustment to their Grade Point Average. This form is used for these purposes. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
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| This form allows you to petition to enroll in a class after the deadline. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu. |
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| Address Change Request | This form allows you to update your contact information. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| If you have previously completed a course with a passing grade, and with to repeat it, you may use this form to petition to repeat the course. One of the options included on the form must be selected and documentation must be submitted with the completed form. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
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| If you have attempted a course 2 times, and received a 'W', 'D', 'F', or 'NP' grade, you must submit this form before your 3rd attempt of the course. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu . |
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| This form allows you to petition for credit for approved courses through an exam. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
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| This form allows you to petition to drop a course after the deadline with a Withdrawal (W) grade
due to an extenuating circumstance such as accident, illness, or other circumstances beyond the control of the student. Documentation of the extenuating circumstance is required. |
Download, save and complete this form. Then print, sign and date it. Fax the form and documentation to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu
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This form allows you to petition to drop a course after the deadline with a Withdrawal (W) grade due to an extenuating circumstance such as accident, illness, or other circumstances beyond the control of the student. Documentation of the extenuating circumstance is required. |
Download, save and complete this form. Then print, sign and date it. Fax the form and documentation to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
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| FERPA Release Form | Student record information is not released to others without written authorization from the student. This form allows you to request a release of educational records on a one-time basis to another party. |
Download, save and complete this form. Then print, sign and date it. Mail the paper form to Admissions and Records, 1000 Hensley Creek Rd, Ukiah CA 95482. |
| Graduation Application | An application for graduation is required to be awarded an Associate's degree. |
You may apply online for graduation through your MyMendo account or by submitting the Graduation Application form. To submit the paper form, download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Guardian Affidavit | Students under the age of 19 in the care of a guardian that have been flagged for additional residency documentation should complete and submit this form. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
| Independent Studies | You can petition to pursue study beyond the courses offered through the current college catalog. This form should be completed with a full-time faculty in the discipline you wish to study. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
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Complete this form if you have missed the deadline for requesting Pass/No Pass grading, you may petition for the grading option retroactively if there are extenuating circumstances which prevented placing the request prior to the deadline. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Matriculation Exemption | Students that do not wish to complete the matriculation services (developing an education plan, placement, etc.) may submit this exemption form. Note, students approved for exemption from matriculation services will not be eligible for priority registration. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
| Name Change, Legal |
Complete this form and submit with a photocopy of a valid photo ID (e.g., driver's license, state ID card, passport) or legal document showing your new name. |
Download, save and complete this form. Then print, sign and date it. Mail the paper form and documentation to Admissions and Records, 1000 Hensley Creek Rd, Ukiah, CA 95482. |
| Name Change, Preferred |
Use this form to request a “preferred first name” change that will display on class and grade rosters. All documents and/or records such as official transcripts, diplomas, etc., will reflect your legal name, not the preferred name. |
Download, save and complete this form. Then print, sign and date it. Mail the paper form and documentation to Admissions and Records, 1000 Hensley Creek Rd, Ukiah, CA 95482.. |
| Out-of-State University Affidavit | Use this affidavit if you have recently attended an out-of-state university or college as a non-resident student and need to establish residency for tuition purposes at Mendocino College. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it to registration@mendocino.edu |
| Overlapping Classes Request | This form allows students to enroll in two overlapping classes as long as the overlap does not exceed 8.0 hours for the semester and the missed hours are made up within the semester. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Pass/No Pass Grading Option Request | Pass/No Pass is a grading option which permits you the opportunity to explore classes in which you are interested without undue concern for your grade point average. When this option is selected, a grade of Pass is issued when the equivalent of a grade of 'C' or better is earned and a grade of No Pass is issued when the equivalent of a grade of 'D' or 'F' is earned. Students are encouraged to meet with a counselor before selecting this grading option. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Prerequisite Challenge Form | This form may be used to challenge a prerequisite or corequisite for a course. In addition to completing the form, a written statement must be provided as well as documentation supporting the reason selected for the challenge. |
Download, save and complete this form. Then print, sign and date it. Fax the form, written statement, and supporting documents to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Prerequisite Equivalency Form | If you have met the prerequisite or corequisite for a course through coursework completed at another college, please submit this form along with unofficial transcripts from the other college. |
Download, save and complete this form. Then print, sign and date it. Fax the form and unofficial transcripts to 707-468-3430 or email to registration@mendocino.edu. |
| Priority Registration Loss Appeal | If you have lost your priority registration, this form can be submitted to appeal the loss and have your priority reinstated. A written statement, a current education plan, and supporting documentation must be submitted with the completed form. |
Download, save and complete this form. Then print, sign and date it. Fax the form, written statement, current education plan, and supporting documentation to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Refund Request |
Refunds are automatically generated when a course in which a student is enrolled is cancelled, the course is dropped prior to the advertised deadline, the course is administratively dropped for failing to meet a prerequisite, or there is a district action which caused a program change. If a refund was not received and should have been for one of the above reasons, please submit this form to request a refund/reversal of fees. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu
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| Residence Questionnaire | If you have been deemed a non-resident for tuition purposes, this form will allow you to provide additional information for consideration for residency. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
| Request to Withhold Directory Information |
Privacy of student records is of the upmost importance and FERPA requirements are applied to all student records and protected student record information is not released to others without the written consent of the student. FERPA allows the college to release some information, called Directory Information, without the written consent of the student unless the student has opted to withhold this information. This form allows you to have your Directory Information withheld unless you choose to allow release through written authorization. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Reverse Pass/No Pass Grading Request | This form will allow you to petition to reverse a previously selected Pass/No Pass grading option. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Seasonal Agricultural Worker Verification |
You may be classified as a resident for tuition purposes if you, or your parent, earns a livelihood primarily by performing agricultural labor (seasonal employment in connection with actual production of agricultural crops, including seeding, thinning and harvesting) for hire in California and other states for at least two months per year in each of the two preceding years. |
Download, save and complete this form. Then print, sign and date it. Fax the form, and associated documents, to 707-468-3430 or email to registration@mendocino.edu. |
| Special Admission Application | Students enrolled in high school and college at the same time (sometimes called dual enrollment) must submit approval for the college courses from their high school and parent/guardian. This form should be used for this approval and is required of all dual enrollment students prior to enrollment. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email to registration@mendocino.edu. |
| Special Admission NonResident Tuition Exemption Form |
Special admission (or dual enrollment) students who are determined to be nonresidents may be exempt from paying nonresident tuition. If you believe you may be eligible for this exemption, please complete and submit this form along with your high school transcript. This exemption does not apply to : o Students who reside outside of California and enroll via Distance Education; o Students on most nonimmigrant visas (e.g., F-1 International Student visas, etc.). T and U nonimmigrant visas are eligible for this exemption. |
Download, save and complete this form. Then print, sign and date it. Fax the form and high school transcript to 707-468-3430 or email to registration@mendocino.edu. |
| Student Representative Fee Refusal Form | All students are billed the $2.00 student representation fee. This fee may be refused in writing by completing this form. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Student Status Change | If you are currently attending Mendocino College, and have recently graduated (or will soon graduate) from high school, or are 18 or older and have ceased attending high school, this form must be submitted to change your status from a dual enrollment student to a regular college student. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Transcript Request Form | Students must request official transcripts through the authorized online service or in writing through submission of the transcript request form. |
Students are encouraged to use the online transcript request service, Parchment. If you choose to request transcripts through the paper request form process, download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |
| Transfer Work Evaluation Request Form | Students that have attended another accredited college or university may request evaluation of their coursework for Mendocino College credit. |
Download, save and complete this form. Then print, sign and date it. Fax the form to 707-468-3430 or email it from your MC Gmail address to registration@mendocino.edu |