Montgomery College Workforce Development & Continuing Education Spring 2015 Kids ds Ki eg ge Co olle C Register Now Enrichment Courses for Students Grades K-12 Courses are offered after school and on Saturdays on the Germantown, Rockville and Takoma park/silver spring campuses Asistencia en Español Disponible www.montgomerycollege.edu/youth 240-567-7917 or 240-567-7264
Arriving soon! Our 2015 mc Summer Youth Program Guide want more youth programs? To see our full list of exciting Youth Program offerings or for more information, please visit our website at www.montgomerycollege.edu/youth or call Youth Programs at 240-567-7264 or 240-567-7917 Asistencia en Español Disponible Inclement Weather If Montgomery College is closed, there are no classes on College campuses. how TO READ A COURSE DESCRIPTION Course name : Web Design Grades/Ages : Grades 5 8 The worlds of web and visual arts collide in this cutting edge introductory course. Learn to make your own website and how to take professional pictures and import them to your site. Explore the basics of color theory and make your website pop with dynamic animations created in Flash. Create anything from a basic web page to an innovative, artistic site with interactive functions. Then publish your vision online to share with friends, family, and the world to see! Instructor: David Hill Couse # # hours course meets Course: YOU456 24 Hours Tuition and fees $150 + $50 fee = $200; Non-Md. residents add $25 Location Germantown Campus CRN # # of sessions CRN#: 36259 Dates Day 2/28 5/9 S Exception dates Time No class 3/21, 4/11, 5/16 9 a.m. 12 p.m. SAMPLE Days of Week M=Monday T=Tuesday W=Wednesday R=Thirsday F=Friday S=Saturday U=Sunday PREP Montgomery College offers SAT and ACT Prep courses on all MC campuses and at local high schools. See our website for course schedules and a link to our Facebook page! www.montgomerycollege.edu/wdce/ satprep.html For more information, please e-mail laura.weihrauch@montgomerycollege.edu or call 240-567-1862 2 www.montgomerycollege.edu/wdce/youth
Algebra I Grades 5 8 (GT) Topics covered include properties of exponents, linear equations and inequalities, ratios and proportions, systems of equations, quadratics, clever factorizations, complex numbers, functions (linear, quadratics, higher-degree polynomials, exponential, logarithmic), sequences, and series. Instructor: Zenia Yang Course: YOU652 15 Hours $300 + $60 fee = $360; Non-Md. residents add $25 CRN#: 36287 6 Sessions 3/14 5/9 S No class 3/21, 4/4, 4/11 1:30 4 p.m. Cartooning, Comics and Manga Grades 5 9 Explore the many forms of cartoon drawings (caricatures, one-panel sight gags, and editorial cartoons), comic strips/books (superhero comics, adventurous illustrations, westerns sci-fi, and detective comics), long-form illustrated narratives (graphic novels, non-fiction subjects), and Japanese manga. Apply your powers of observation and imagination to a variety of projects: creating original characters, designing pages, drawing caricatures, making flip books, and developing a comic strip/book. You will be encouraged to experiment with various drawing media and techniques. Instructor: Ellen Vartanoff Course: YOU159 12 Hours $125 + $45 fee = $170; Non-Md. residents add $25 CRN#: 36230 3/3 5/5 T No class 3/17, 4/7 4:45 6:15 p.m. College Success Institute (Online) Grades 8 11 Learn about college readiness and success online! In this hybrid online course, you ll meet face-to-face every other week to explore, learn and implement the six-point college success model. Topics include setting goals, building self-esteem and confidence, and exploring careers. Other weeks, you ll work online to examine various motivational strategies; analyze learning styles; and practice strategies for effective note taking, writing, speaking, and test preparation. If you are planning to go to college, then this is a course you don t want to miss! Students will meet in class on March 11, April 1, April 22, and May 6, 2015. Instructor: Nicole Better-Fitzhugh Course: YOU638 10.5 Hours $135 + $45 fee = $180; Non-Md. residents add $25 CRN#: 36271 7 Sessions 3/11 5/6 W No class 3/18, 4/8 5:30 7 p.m. Engineering FUNdamentals Using LEGO Ages 9 12 Power up your engineering skills with Play-Well TEKnologies and tens of thousands of LEGO! Apply realworld concepts in physics, engineering, and architecture through engineer-designed projects such as arch bridges, skyscrapers, motorized cars, and the Battletrack! Design and build as never before, and explore your craziest ideas in a supportive environment. An experienced instructor will challenge new and returning students to engineer at the next level. Course: YOU640 12 Hours $150 + $50 fee = $200; Non-Md. residents add $25 CRN#: 36289 3/5 5/7 R No class 3/19, 4/9 4 5:30 p.m. Drivers Education Did you know that Montgomery College WD&CE offers Driver Education Training and Behind-the-Wheel Training? For more information or registration, contact Marcy Jackson at 240-567-2589 or e-mail marcy.jackson@montgomerycollege.edu. You can also visit our website at www.montgomerycollege.edu/wdce/bits/driversafety.html. 240-567-7917 or 240-567-7264 3
Financial Fitne$$ for Teens Grades 6 8 (GT) Have you ever wanted to buy an IPod, IPad, or video game, but couldn t afford it? If so, this course is the one for you. Learn how to take your money and use it wisely, buy the things you want, and still have money in the bank! Participate with your friends in many exciting activities, including Financial Bingo and Jeopardy. Play skill-building board games like Real-World Math which unlocks your goal-setting, savings, and money management skills. On the last day, show what you ve learned by competing with your classmates and parents in Team Financial Bingo. Climb aboard today and learn to manage your money like an expert. This course meets State and National personal finance standards. Instructor: Afarin Homer Course: YOU539 16 Hours $155 + $55 fee = $210; Non-Md. residents add $25 CRN#: 36260 3/6 5/15 F No class 3/20, 4/3, 4/10 4 6 p.m. Geometric Animals Grades 3 5 Join us in this workshop to explore methods of creating an animal collage. Practice drawing techniques with a variety of pencils, marker, charcoal pencil, colored pencils, and conte. Instructor: Jennifer Pawlak Course: YOU643 9 Hours $95 + $45 fee = $140; Non-Md. residents add $25 CRN#: 36237 6 Sessions 3/7 5/2 S No class 3/21, 4/4, 4/11 9:30 11 a.m. Geometry Grades 6 9 (GT) Topics covered include properties of two- and threedimensional geometric shapes and development of mathematical arguments about geometric relationships (proofs). Instructor: Zenia Yang Course: YOU653 15 Hours $300 + $60 fee = $360; Non-Md. residents add $25 CRN#: 36288 6 Sessions 3/14 5/9 S No class 3/21, 4/4, 4/11 4:15 6:45 p.m. Introduction to Sewing Ages 10 16 Learn how to use a sewing machine and how to sew a variety of fun projects that you ll take home and use right away. Hand sewing techniques will also be covered. Sewing machines will be provided for classroom use. If a student already owns a machine s/he may bring it to a later class, but please do NOT purchase a new machine before class begins. All materials will be provided. Instructor: Anne LeVeque Course: YOU636 20 Hours $140 + $45 fee = $185; Non-Md. residents add $25 Takoma Park/Silver Spring Campus CRN#: 36182 10 Sessions 2/23-5/11 M No class 3/16, 4/6 4-6 p.m. Keyboarding for Computers Grades 4 6 Want to become a typing wizard! Using state-of-the-art IBM compatible computers (one per student) and other tools, learn the correct finger placement on the computer keyboard, including letters, numbers, and symbols. Build skills with drills and timed writings. Learn basic MS Word concepts, including formatting a letter and a table. Instructor: Janet Bergman Course: YOU553 16 Hours $100 + $45 fee = $145; Non-Md. residents add $25 CRN#: 36233 3/4 5/6 W No class 3/18, 4/8 4:15 6:15 p.m. Magic of Line Drawing Grades 5 8 Learn the basic concepts of line drawing while working with still life objects. Gain confidence using a variety of materials, and explore techniques of form, shape, and perspective using angle and curve lines to develop contour and continuous contour to free line blind contour that gives tone and structure to still life objects. Instructor: Jennifer Pawlak Course: YOU649 16 Hours $110 + $50 fee = $160; Non-Md. residents add $25 CRN#: 36286 3/5 5/7 R No class 3/19, 4/9 4 6 p.m. 4
Mathematical Circles Grades 6 8 This outreach program brings mathematicians into direct contact with pre-college students. These students meet with a mathematician or two in an informal setting, after school, to work on interesting problems or topics in mathematics. The goal is to get the students excited about the mathematics they are learning, and to give them a setting that encourages them to become passionate about mathematics. Course: YOU655 12 Hours $75 + $35 fee = $110; Non-Md. residents add $25 Germantown Campus CRN#: 36309 3/2 5/4 M No class 3/16, 4/6 4 5:30 p.m. My Money MatterZ I Grades 4 6 (GT) Jump-start into lifelong financial responsibility! Boost yourself above most adults by discovering money smarts in this activity-packed class. Learn basic economics: how to make and spend money, how it works in the real world, and what it s good for. Develop personal responsibility and practical knowledge while having fun with games, stories, and big ideas, like human capital and opportunity cost. Now is the best time to begin understanding money to create a lifetime of financial peace. Sign up now and bring your friends along too! This dynamic program meets State and National Personal Finance Standards. Instructor: Homer Afarin Course: YOU281 15 Hours $155 + $55 fee = $210; Non-Md. residents add $25 CRN#: 36261 3/14 5/2 S No class 3/21, 4/4, 4/11 9 a.m. 12 p.m. Summer Youth Programs at Montgomery College! Over 200 Fun-Filled Classes for Grades K 12 POM Squad! Ages 11 13 Join the POM SQUAD for a DEAL (Dancing, Empowerment, and Leadership)!! This course is a unique dance and mentoring program. Learning to dance is fun and having someone to talk to doubles the pleasure. Each session combines dance and mentoring to help you focus on issues relevant to you, such as bullying, peer pressure, communication, and building self-confidence and self-determination. Learn how to dance to fun, upbeat, popular music from a professional dance instructor and Redskins cheerleader. Explore dance styles like jazz, ballet, hip-hop, etc. End the course with a performance for family and friends. Instructor: Latasha Better-Fitzhugh Course: YOU644 16 Hours $135 + $50 fee = $185; Non-Md. residents add $25 CRN#: 36270 3/4 5/6 W No class 3/18, 4/8 6 8 p.m. Ribbon Landscapes Grades 6 8 Study drawing and painting concepts using a multimedia approach that helps you gain confidence with using varied materials. This course covers the fundamentals of composition, design, perspective, and construction. You ll learn to work in charcoal, pencil, watercolor, and acrylic. Instructor: Jennifer Pawlak Course: YOU642 9 Hours $95 + $45 fee = $140; Non-Md. residents add $25 CRN#: 36236 6 Sessions 3/7 5/2 S No class 3/21, 4/4, 4/11 1:30 3 p.m. Art, Biotechnology, Chemistry, Cooking, Computer Graphics, Electronics, Math, Music, Reading, Robotics, Science, Sports, Theatre, Web Design, Writing, Yoga, AND SO MUCH MORE!!! Schedule coming soon! For more information, visit our website at www.montgomerycollege.edu/youth or call Youth Programs at 240-567-7264 or 240-567-7917 240-567-7917 or 240-567-7264 5
SOS for Middle School Students Grades 6 8 Learning good study habits now will lay the groundwork for successful work habits as an adult. SOS is designed to provide background knowledge, resource materials, and suggestions that will relieve academic distress and help you optimize your success as a lifelong learner. This course is academic relief at your fingertips! Learn to use academic and practical tools to increase your likelihood for success, including organizational tools, time management techniques, test preparation and test-taking strategies, note-taking guidance, and personal responsibility tips. Instructor: Don Milner Course: YOU440 16 Hours $140 + $45 fee = $185; Non-Md. residents add $25 CRN#: 36231 3/5 5/7 R No class 3/19, 4/9 5 7 p.m. Writing Basics Grades 7 10 Become comfortable with grammar the basis for clear, correct writing. Starting with a review of the parts of speech and the jobs they do in a sentence, this course will move to more complex grammatical concepts and will guide you toward building strong writing skills. Games and puzzles will be interspersed to both challenge and entertain, and small lesson-based writings will be completed in class each week. NOTE: A short break will be offered; students are invited to bring a drink and a snack with no nut products, or money for the vending machines. Instructor: Geraldine Green Course: YOU650 14 Hours $125 + $45 fee = $170; Non-Md. residents add $25 CRN#: 36285 7 Sessions 3/7 5/16 S No class 3/21, 4/4, 4/11, 4/25 9 11 a.m. Web Design Grades 6 8 The worlds of web and visual arts collide in this cutting edge introductory course. Learn to make your own website and how to take professional pictures and import them to your site. Explore the basics of color theory and make your website pop with dynamic animations created in Flash. Create anything from a basic web page to an innovative, artistic site with interactive functions. Then publish your vision online to share with friends, family, and the world to see! Instructor: David Hill Course: YOU456 24 Hours $150 + $50 fee = $200; Non-Md. residents add $25 Germantown Campus CRN#: 36259 2/28 5/9 S No class 3/21, 4/4, 4/11 9 a.m. 12 p.m. Writing the Essay for the SAT/ACT Grades 9 12 Get prepared for the writing section of the SAT/ACT. Analyze typical essay prompts and sample responses, and heighten your comfort with the testing situation. Learn to support your opinions by using your own experiences and readings to accomplish the task of writing to a persuasive prompt. Using logical thinking, enhance your awareness of the structure of your arguments and avoid fallacies in reasoning. Practice writing the parts of an essay, composing entire essays, and revising and evaluating your own writing and that of your peers. Increase your ability to write in timed situations. Add rhetorical strategies to your repertoire of writing skills and improve your understanding of Standard English usage through direct instruction and practice. Practice writing in timed situations. Instructor: Jennifer Bauer Course: YOU651 12 Hours $135 + $45 fee = $180; Non-Md. residents add $25 CRN#: 36284 3/4 5/6 W No class 3/18, 4/8 4 5:30 p.m. 6
Germantown Baseball Clinic For teams of up to 20 players If you are a coach of a baseball team and you want to get a jump start on your season by practicing as a team, then this clinic is for you. Take this opportunity to work on baseball skills and get ready for spring. The players and coaches of the 2014 Raptor baseball team will provide instruction in hitting, pitching, fielding, and throwing. The clinic will be held in the Montgomery College Germantown indoor facility which includes two batting cages, pitching mounds, and plenty of space for infield and outfield work. Head Coach: Dan Rascher Course: YOU053 7.5 Hours $50 + $40 fee = $90; Non-Md. residents add $25 Germantown Campus CRN#: 36223 1/16 2/13 F 6 7:30 p.m. CRN#: 36224 1/16 2/13 F 8 9:30 p.m. CRN#: 36216 1/17 2/14 S 7 8:30 p.m. CRN#: 36217 1/17 2/14 S 9 10:30 a.m. CRN#: 36218 1/17 2/14 S 3 4:30 p.m. CRN#: 36219 1/17 2/14 S 1 2:30 p.m. CRN#: 36222 1/17 2/14 S 11 a.m. 12:30 p.m. CRN#: 36220 1/18 2/15 U 1 2:30 p.m. sports CLINICS CRN#: 36221 1/18 2/15 U 11 a.m. 12:30 p.m. CRN#: 36225 1/18 2/15 U 3 4:30 p.m. CRN#: 36226 1/18 2/15 U 5 6:30 p.m. CRN#: 36227 1/18 2/15 U 7 8:30 p.m. Germantown Baseball Clinic Players: Ages 5 13 Take this opportunity to work on baseball skills and get ready for spring. The players and coaches of the 2014 Raptors baseball team will provide instruction in hitting, pitching, fielding, and throwing. The clinic will be held in the Montgomery College Germantown indoor facility which includes two batting cages, pitching mounds, and plenty of space for infield and outfield work. Head Coach: Dan Rascher Course: YOU548 10.5 Hours $110 + $50 fee = $160; Non-Md. residents add $25 Germantown Campus CRN#: 36228 7 Sessions 1/10 2/21 S 5 6:30 p.m. CRN#: 36229 7 Sessions 1/11 2/22 U 9 10:30 a.m. 240-567-7917 or 240-567-7264 7
Germantown Campus Montgomery College Germantown Campus 20200 Observation Drive Germantown, 20876 (240) 567-7700 www.montgomerycollege.edu/maps/ The Germantown Campus is located in upper Montgomery County, Maryland, just east of I-270. All buildings at the Germantown Campus are fully accessible. Directions to the Germantown Campus By Car: Take I-270 to Exit 15 East (Route 118). Continue to the second traffic light at Observation Drive; turn right onto campus. By Metro: Take Red Line train to Shady Grove station and transfer to Ride-On Bus Route 55 to on-campus stop. By Bus: The campus is served by Ride On Bus with connections to Metrorail. Legend of Buildings PK Paul Peck Academic/Innovation GN Green House HS Humanities and Social Sciences Building HT High Technology and Science Center OA Office Annex PG Physical Education Complex SA Sciences and Applied Studies Building (Security Office and Admissions and Records) PK 8
Montgomery College 51 Mannakee Street Rockville, MD 20850 240-567-5000 www.montgomerycollege.edu/maps/ Legend of Buildings AR Paul Peck Art Building By Car From the North: Take I-270 South to Exit 6 (Route 28), W. Montgomery Ave./Rockville. Then take Exit 6A (Route 28) East. Turn left at first traffic light onto Nelson Street. Go to first traffic light at Mannakee Street; turn left. The campus is 1.5 blocks on the left. From the South: Take I-495 to I-270 North/Frederick. Exit on 6A (Route 28, W. Montgomery Ave./Rockville) 1/4 mile north of Montrose Road exit. Follow Montgomery College sign through traffic light (road becomes Nelson Street). Go to first traffic light at Mannakee Street; turn left. The campus is 1.5 blocks on the left. Public Transportation to By Metro Take the Red Line train to Rockville station, then transfer to Metrobus #Q2 (Viers Mill Road Line) to campus stop at corner of Hungerford Drive and Mannakee Street. By Bus Take Metrobus #Q2 (Viers Mill Road Line which runs between Silver Spring and Shady Grove Metro stations) to campus stop at corner of Hungerford Drive and Mannakee Street. AT CB CC CH CS GU HU MK MT MU PA PE RA SB SE SV SW TA TC TT Amphitheatre Counseling and Advising Building (Security Office) Campus Center Child Care Center Computer Science Building Homer S. Gudelsky Institute for Technical Education Humanities Building Mannakee Building (Central Administration) Gordon and Marilyn Macklin Tower Music Building Robert E. Parilla Performing Arts Center Physical Education Center Rockville Annex South Campus Instruction Building Science East Building Student Services Building (Admissions and Records) Science West Building Theatre Arts Building Technical Center Interim Technical Training Center 240-567-7917 or 240-567-7264 9
TAKOMA PARK/SILVER SPRING Campus Montgomery College Takoma Park/Silver Spring Campus 7600 Takoma Avenue Takoma Park, 20912 (240) 567-7700 www.montgomerycollege.edu/maps/ Legend of Buildings CF Cafritz Arts Builgin CM Catherine Scott Commons CU Cultural Arts Center DC Child Care Center EG East Garage (parking) FH Falcon Hall HC Health Sciences Center MP Mathematics Pavilion NP North Pavilion P 1-4 Pavilions 1-4 RC Resource Center SN Science North SS Science South ST Student Services Center WG West Garage Directions to the Takoma Park/Silver Spring Campus By Car Take I-495 West to Exit 31 or East to Exit 31B, Georgia Avenue South (Route 97). Continue south on Georgia Avenue past the Colesville Road (Route 29) intersection. Following the signs for Montgomery College, turn left (East) on Sligo Avenue. Follow Sligo Avenue to Fenton Street; turn right. Continue (southbound) on Fenton Street through the traffic light at Philadelphia Avenue (Route 410). The East Garage is just ahead on your right, and the campus itself begins one block farther at New York Avenue and Fenton Street. The West Garage is located off Georgia Avenue on Jesup Blair Drive. By Metro Take Red Line train to Silver Spring station, then transfer to Ride On Bus Route 17 or 18. By Bus The campus is served by both Ride On Bus and Metrobus routes with connections to Metrorail. 10
GENERAL INFORMATION & Registration Options Please follow these instructions. Use one form for each student. 1. Make course selection(s). 2. Register online using your credit card (VISA, MasterCard, or Discover) at www.montgomerycollege.edu/youth. 3. OR download and complete a Registration Form. Be sure to include student s MC Identification Number. 4. For courses indicated as Gifted and Talented [GT], an additional form signed by a school official is required. You can download this form at http://www.montgomerycollege.edu/wdce/youthpdf/youthprograms_gt.pdf. 5. 4 Ways to Register 1. Web: http://www.montgomerycollege.edu/wdce/youth.html. Look for registration link under the program area. 2. Fax: Youth Programs: 240-567-7548 Please indicate your credit card payment information. 3. Mail: Mail form(s) and full payment to: Montgomery College, Workforce Development & Continuing Education, Youth Programs, 51 Mannakee Street, CC220, Rockville, MD 20850. Please make all checks payable to Montgomery College. American Express, Visa, MasterCard, and Discover are also accepted for payment. 4. Walk in: Registration(s) must be brought to the Campus Center building,, Room 220. 6. Registrants will be enrolled in the order that registration and payments are received. Therefore, we urge you to register as early as possible to avoid disappointment. You will receive acknowledgment of registration. Please call Customer Service at 240-567-5188 if Registration Confirmation is NOT received at least five days before the start of classes. Classrooms and specific locations will be stated on this acknowledgement. Courses may be canceled due to low enrollment. 7. All students must register prior to attending class; do not attend class if you have not registered in advance. 8. Pending funding, partial scholarships may be available for Montgomery County students who demonstrate financial need or qualify for free or reduced lunch. Call 240-567-7264 or 240-567-7917 for information. Residency Policy The following are general guidelines taken from the College policy on residency for tuition purposes. A copy of the policy is available in the Montgomery College Catalog. A. Students attending Montgomery College will pay tuition according to their residency. B. To qualify for tuition purposes as a resident of the state of Maryland, legal domicile must have been maintained for a period not less than three months prior to the first regularly scheduled class. Non-Maryland residents must pay a $25.00 out-of-state fee. C. The domicile of a person registering in a noncredit course at Montgomery College shall be considered as a person s permanent place of abode, where physical presence and possessions are maintained, and where he/she intends to remain indefinitely. D. Non-U.S. citizens must submit copy of passport visa or permanent resident card. E. Non-Maryland residents and Non-U.S. citizens pay Out-of-State fees. Refund Policy Youth Programs Only: Class Transfer and/or Class Withdrawal/Drop Fees 1. Class Transfer Requests: Students will be allowed to transfer from one class to another, one time without a charge. Any additional schedule changes will be reviewed and may be subject to a $20.00 fee. 2. Youth Class withdrawal/drop request: Parents who wish to withdraw their child from a course will receive 100 percent refund if written request is received at Montgomery College at least 5 business days prior to the start of the class. Requests to withdraw from a class received within 5 business days of the start of the class will be subject to a fee of $50.00. 3. Requests for refunds may be completed by e-mailing the Youth Programs office at sharon.wolfgang@montgomerycollege.edu or karla.espinoza@montgomerycollege.edu or by calling 240-567-7264 or 240-567-7917. Please allow 3 4 weeks for refunds. Contributions to the Youth Scholarship Fund You may take advantage of this easy way to make a tax deductible contribution to the College s Youth Scholarship Fund by writing an amount in the place provided on the Registration Form. Disability Support Services Montgomery College Youth Programs is committed to providing accessible education and a supportive learning environment for all students. To help us meet this goal, after you have registered, contact our WD&CE Disability Support Services counselor Natalie Martinez at natalie.martinez@montgomerycollege.edu or 240-567-4118 at least four weeks before the start of the program to inform the College of any physical disabilities or behavioral / social challenges your child has and to arrange for reasonable accommodations. MC does not provide medical assistants or care attendants. Parents are not permitted to attend camp with their child. The exception to this is for those attending an Intergenerational Program specifically designed for Youth accompanied by Adult(s). Transportation Students and their parents or guardians are responsible for all transportation arrangements. Public transportation is available. Call Montgomery County Transit Information at 301-217-RIDE. Health Services Should a medical emergency occur, trained personnel from the Campus Security Office will be available to render aid. Questions? You may call anytime Mon Fri 9 a.m. 4 p.m. : 240-567-7917 or 240-567-7264 240-567-7917 or 240-567-7264 11
For Registration Assistance call 240-567-7917 or 240-567-7264. Kids College Registration Form Montgomery College Workforce Development & Continuing Education www.montgomerycollege.edu/youth (Please use black pen when completing this form) MC Identification No. Name (Last) (First) (Middle) (This is your Student ID Number. If you have taken courses at MC previously, you should have one. If M F Ext. not, the College will assign your MC (Circle) Date of Birth Home Phone Parent s Business Phone Identification Number for you.) Parent s Name (Last) (First) Parent s E-mail Apt. No. House No. Street Address (Check box if new address ) City State School Currently Attending Zip Code Current Grade U.S. Citizen Non U.S. Citizen (Non U.S. Citizens attach copy of your passport visa or permanent resident card) CODE: KC Have you attended MC before? Yes No (Citizen status used for tuition-setting purposes only.) CRN # Course Title Begin Tuition Date Fee Out-of- State Fee Course Total Optional Contribution to Scholarship Fund Indicate payment by: Total Due check (payable to Montgomery College) VISA MasterCard American Express Discover Credit Card Information: Name on Card Expiration Date Card Number 3 or 4 digit Security Code from back of card: Signature Your Name (If different than name on card) Please mail this form with your payment or credit card information to: Montgomery College Workforce Development & Continuing Education Kids College 51 Mannakee Street, CC220 Rockville, MD 20850 OR FAX to: 240-567-7548 Montgomery College reserves the right to use, photograph, reproduce, and publish any work produced by students as part of their educational program. Work is defined as intellectual property as defined or recognized by law and custom created or developed through the application of intellectual efforts by one or more persons. Unless otherwise agreed, work will not be used for any purpose other than educational and to support the mission of the College. I affirm that the information recorded on this application is correct. My child is a Maryland resident and lives in County. I understand that my son/daughter will be attending classes on an open college campus and there will be no student supervision provided outside the classroom. He/she will abide by the rules and regulations of Montgomery College, including exhibiting classroom behavior that allows for a study environment free from harassment, discrimination, and disruption. Behavior contrary to this will not be tolerated and may result in expulsion. Should a medical emergency occur, I grant authority to the Montgomery College Campus Security staff to provide necessary and reasonable medical attention to: Student s Name Parent/Guardian Signature Date I give my permission to have my child s photograph and/or testimonial used in media promotions in conncection with registration and other media campaigns produced by Montgomery College. Parent/Guardian Signature Date RACE: Choose all that apply, you may choose more than one. (Disclosure not mandatory by Montgomery College, but is required by the U.S. Dept. of Education.) American Indian or Alaskan Native Asian Black or African American Native Hawaiian and other Pacific Islander White ETHNICITY: Choose one. (Disclosure not mandatory by Montgomery College, but is required by the U.S. Department of Education.) Not Hispanic or Latino Hispanic or Latino None If your child carries an Epi Pen or takes medication, additional forms are required for registration. For more information, please visit www.montgomerycollege.edu/wdce/youth/forms.html. 9/2/09