Student Dbase Form

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Agriculture & Environmental Sciences
Student Division Information Form

(* - required)

First Name:

Middle Name:

Last Name:

Address:

City:

State:

Postal Code (ZIP):

Telephone Number:

( ) *

Alternate Telephone Number:

( )

Email address:

Permanent Information:

Mother's First Name:

Mother's Last Name:

Father's First Name:

Father's Last Name:

Address:

City:

State:

Postal Code (ZIP):

Academic Information:

Major:*

Select all that apply

Agriculture Business Programs

Agriculture Business, A.S.

Agricultural Science Programs

Agriculture Sales & Service, A.S.

Agriculture Sales and Service (Certificate Only)

Agriculture Science, A.S.

Animal Science Programs

Animal Science, A.S.

Dairy Industry, A.S.

Dairy Science, A.S.

Poultry Science, A.S.

Artificial Insemination (Certificate Only)

Environmental Horticulture Programs

Environmental Horticulture Science, A.S.

Landscape Architecture, A.S.

Commercial Floristry (Certificate Only)

Landscape / Park Maintenance (Certificate Only)

Landscape Design (Certificate Only)

Nursery Production (Certificate Only)

Food Processing Programs

Agriculture Laboratory, A.S.

Food Processing, A.S.

Agriculture Laboratory (Certificate Only)

Food Processing (Certificate Only)

Forestry/Natural Resources

Forestry, Professional, A.S.

Recreational Land Management, A.S.

Vocational Forestry, A.S.

Forestry Technician (Certificate Only)

Recreational Land Management Technician (Certificate Only)

Mechanized Agriculture Programs

Mechanized Agriculture, A.S.

Mechanized Agriculture (Certificate Only)

Plant Science Programs

Crop Science, A.S.

Fruit Science, A.S.

Soil Science, A.S.

Other / Undeclared

Non-Agriculture Degree at MJC

GE Requirements for Transfer only

Undeclared / Other

AgEns Classes Enrolled in this Semester *

Please Check all classes you are currently enrolled in.

Academic Plans: