Kids. Register Now. Spring Montgomery College Workforce Development & Continuing Education

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Montgomery College

Workforce Development

& Continuing Education

Spring 2015

Register

Now

Kids’

College

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

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Arriving soon!

Our 2015 mc

Summer Youth

Program Guide

If Montgomery College is closed, there

are no classes on College campuses.

Inclement Weather

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 intro-ductory 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 inno-vative, 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 8 Sessions Dates Day 2/28–5/9 S

Exception dates Time

No class 3/21, 4/11, 5/16 9 a.m.–12 p.m.

Days of Week

M=Monday T=Tuesday W=Wednesday R=Thirsday F=Friday S=Saturday

U=Sunday

SAMPLE

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

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 [email protected]

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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

Rockville Campus

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

CRN#: 36230 8 Sessions 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

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 real-world 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.

CRN#: 36289 8 Sessions 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

[email protected]. You can also visit our website at www.montgomerycollege.edu/wdce/bits/driversafety.html.

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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

Rockville Campus CRN#: 36260 8 Sessions 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

Rockville Campus 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 three-dimensional geometric shapes and development of mathematical arguments about geometric relationships (proofs). Instructor: Zenia Yang

Rockville Campus 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

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

CRN#: 36233 8 Sessions 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

CRN#: 36286 8 Sessions 3/5–5/7 R

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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.

Germantown Campus CRN#: 36309 8 Sessions 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

Rockville Campus CRN#: 36261 5 Sessions 3/14–5/2 S No class 3/21, 4/4, 4/11 9 a.m.–12 p.m. 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

Rockville Campus CRN#: 36270 8 Sessions 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

Rockville Campus CRN#: 36236 6 Sessions 3/7–5/2 S No class 3/21, 4/4, 4/11 1:30–3 p.m.

Summer Youth

Programs

at Montgomery College!

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!

Over 200 Fun-Filled

Classes for Grades K–12

For more information, visit our website at

www.montgomerycollege.edu/youth

or call Youth Programs at 240-567-7264 or 240-567-7917

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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

Rockville Campus CRN#: 36231 8 Sessions 3/5–5/7 R No class 3/19, 4/9 5–7 p.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

Germantown Campus CRN#: 36259 8 Sessions 2/28–5/9 S No class 3/21, 4/4, 4/11 9 a.m.–12 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

CRN#: 36285 7 Sessions 3/7–5/16 S

No class 3/21, 4/4, 4/11, 4/25 9–11 a.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

CRN#: 36284 8 Sessions 3/4–5/6 W

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sPORTS CLINICS

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

Germantown Campus CRN#: 36223 5 Sessions 1/16–2/13 F 6–7:30 p.m. CRN#: 36224 5 Sessions 1/16–2/13 F 8–9:30 p.m. CRN#: 36216 5 Sessions 1/17–2/14 S 7–8:30 p.m. CRN#: 36217 5 Sessions 1/17–2/14 S 9–10:30 a.m. CRN#: 36218 5 Sessions 1/17–2/14 S 3–4:30 p.m. CRN#: 36219 5 Sessions 1/17–2/14 S 1–2:30 p.m. CRN#: 36222 5 Sessions 1/17–2/14 S 11 a.m.–12:30 p.m. CRN#: 36220 5 Sessions 1/18–2/15 U 1–2:30 p.m. CRN#: 36221 5 Sessions 1/18–2/15 U 11 a.m.–12:30 p.m. CRN#: 36225 5 Sessions 1/18–2/15 U 3–4:30 p.m. CRN#: 36226 5 Sessions 1/18–2/15 U 5–6:30 p.m. CRN#: 36227 5 Sessions 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

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.

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PK

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

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Rockville Campus Legend of Buildings

AR Paul Peck Art Building AT Amphitheatre

CB Counseling and Advising Building (Security Office) CC Campus Center

CH Child Care Center

CS Computer Science Building

GU Homer S. Gudelsky Institute for Technical Education HU Humanities Building

MK Mannakee Building (Central Administration) MT Gordon and Marilyn Macklin Tower MU Music Building

PA Robert E. Parilla Performing Arts Center PE Physical Education Center

RA Rockville Annex

SB South Campus Instruction Building SE Science East Building

SV Student Services Building (Admissions and Records) SW Science West Building

TA Theatre Arts Building TC Technical Center

TT Interim Technical Training Center

Montgomery College

Rockville Campus

51 Mannakee Street

Rockville, MD 20850

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 Rockville Campus

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.

240-567-5000

www.montgomerycollege.edu/maps/

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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.

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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, Rockville Campus, 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 [email protected] or [email protected] 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 stu-dents. To help us meet this goal, after you have registered, contact our WD&CE Disability Support Services counselor Natalie Martinez at

[email protected] 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?

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Kids’ College Registration Form

Montgomery College

Workforce Development & Continuing Education

www.montgomerycollege.edu/youth

(Please use black pen when completing this form)

For Registration Assistance call 240-567-7917 or 240-567-7264.

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

Identification Number for you.) Parent’s Business Phone

Parent’s Name (Last) (First) Parent’s E-mail

Apt. No. House No. Street Address City State (Check box if new address ___ ) Zip Code

School Currently Attending 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 State FeeOut-of- Course Total

Optional Contribution to Scholarship Fund

Total Due 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)

Indicate payment by:

____check (payable to Montgomery College) ___VISA ___MasterCard ___American Express ___Discover

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 informa -tion recorded on this applica-tion 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