EZStart Scholarship

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EZStart Information Request Form

• First Name
• Last Name
• Address
• City
• State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
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• Phone #
• Cell # (optional)
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• Education Status Select... First Time Student Returning Student
• Dipmloma or GED? Select... GED Diploma None
• 
  Special Instructions or Comments (optional):
  
• By pressing the "Submit EZStart Information Request" button below, I hereby state that I understand that I will be contacted by phone, email, or mail by an MCTC representative in regards to the EZStart Program.