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Forms & Documents
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 Welcome to the Online Form Depot of Middlesex Community College. Here you will find online access to forms commonly used at the college.
If you need a form that is not currently online, please send a request to the college webmaster.
 Most of the forms are in Portable Document Format (.pdf). These forms can be read, completed online, saved and printed using Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader or would like to upgrade your current version, you may download Adobe Acrobat Reader.
 Most of the forms are in Portable Document Format (.pdf). These .pdf format forms can be downloaded (using Adobe Acrobat Reader), printed, and filled by hand. If you do not have Adobe Acrobat Reader or would like to upgrade your current version, you may download Adobe Acrobat Reader.
 The word documents can be read, completed, and save using Microsoft Word or any other word processor. These forms can also be downloaded, printed and filled by hand.
 The college has no control of these forms, which are not stored on the MxCC's website. Pending on the format, these forms may be read and printed. Some may be completed online and saved.
Forms for Students
| Form Name | Fillable PDF Form | Nonfillable PDF Form | Word Form | Non-MxCC Forms |
Admissions 
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| Application for Admission |
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| Form I134, Affidavit of Support |
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| Home-Educated College Preparatory Credit Evaluation |
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| MMRV Immunization Requirement |
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| Academic Plan |
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Records
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| Class Registration |
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| Application for Readmit Students |
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| Application for Withdrawal after the Refund Date |
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| Change of Personal Data |
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| Declaration of Audit Status |
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| Late Add Request |
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| Password Reset |
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| Records Release Authorization |
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| Request to Restrict Directory Information |
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| Transcript Request |
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Continuing Education
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| Credit-Free Classes Registration |
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| Certified Nurse Aide Program Application |
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| Certified Nurse Aide Program - Health Form |
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Dean of Administration and Finance
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| Bus Trip Information & Policies |
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| Incident Report |
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| Request for Delinquent Debt Repayment |
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| Student Emergency Information |
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Scholarships and Funds for Students
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| 2012 Scholarship Application |
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Single Parent Line of Hope Operating Procedures
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Single Parent Line of Hope Application
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Artists for World Peace-Artist's Fund Application
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Forms for Faculty and Staff
| Form Name | Fillable PDF Form | PDF Form Filled by Hand | Word Form | Non-MxCC Forms |
Curriculum and Academic Policy
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| Course Proposal & Change Form - Instructions |
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| Course Proposal & Change Form - The Form |
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| Signature Form for All CAP Proposals |
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| Course Outline Template |
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| Early Notification |
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Dean of Administration & Finance
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| Bus Trip Information & Policies |
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| Incident Report |
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| Leave Request |
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| Student Emegency Information |
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Human Resources & Payroll
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| CT-W-4 Tax Withholding Form (Payroll) |
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| Dual Employment Form (PER-DE-1) |
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| Employment Application - Board of Regents/Community Colleges |
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| Employment/Examination Application PLD-1/State of CT |
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| Employment Eligibility Verification (I-9) |
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| Federal W-4 Tax Withholding Form (Payroll) |
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| FMLA - Employee Medical Certificate - 33A |
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| FMLA - Care Giver Medical Certificate - 33B |
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| FMLA HR1 - Employee Leave Request Form |
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| FMLA HR3 - Employee Form - Intent to Return to Work (to be completed before the start of the leave) |
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| FMLA HR2A - HR Employer Response Form - Notice of Eligibility and Rights and Responsibilities |
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| FMLA HR2B - HR Employer Response Form - Designation Notice |
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| FMLA HR2c - HR Employer CORE Coding Form |
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| FMLA Military Leave - Form - WH 384 - (qualifying exigency) . |
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| FMLA Military Leave - Form - WH 385 - (qualifying injury/illness) |
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| Payroll Direct Deposit Form (Payroll) |
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| PER - 126: Service Rating Form, Admin and Clerical (NP-3 Union) |
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| PER - 127: Service Rating Form, Admin and Residual (P-5 Union) |
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| PER - 148: Service Rating Form, Maintenance and Service (NP-2 Union) |
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| CCP/EA Evaluation Form (Congress/4C's union) |
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| Placement on Statewide Transfer List Request Form |
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| Federal W-4 Tax Withholding Form (Payroll) |
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| Promotion Application 4C's/ACL (Contact Human Resources) |
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| Promotion Application 4C's/Faculty (Contact Human Resources) |
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| Request for Taxpayer Identification Number (Form W-9) (Payroll) |
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| Sabbatical Leave Application 4C's (Contact Human Resources) |
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| Tenure Application 4C's (Contact Human Resources) |
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| Tuition Reimbursement Form |
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