Maricopa Reset to Restart Form

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Reset to Restart Program Application

Program Information

Thank you for your interest in the Maricopa Community College Reset to Restart program. Please complete this application to determine your eligibility. If you qualify for the program, a college staff member will contact you. For more information on the Reset to Restart program please visit this website.

The Maricopa Community Colleges are:

Chandler-Gilbert Community College
Estrella Mountain Community College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Community College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Community College

last updated: 06/27/2019

Section A: Student Information

Student ID

College

First Name

Last Name

Date of Birth

E-mail Address

Home Phone Number

Other Phone Number

Section B: Student Acknowledgement

Please read and check each box to acknowledge your understanding of the program requirements for this one-time opportunity.

After acceptance and upon successful completion of all of the program requirements, the Maricopa Community Colleges will award a scholarship in the amount of the Qualifying Outstanding Balance to satisfy that debt; otherwise the Qualifying Outstanding Balance debt will remain owed.

Section C: Electronic Signature

Understanding all of the above requirements of the Reset to Restart Program, I agree to Opt-in to the program.

Enter Student First Name

Enter Student Last Name

The Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the District.
The Maricopa County Community College District does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities. For Title IX/504 concerns, call the following number to reach the appointed coordinator: (480) 731-8499. For additional information, as well as a listing of all coordinators within the Maricopa College system, visit http://www.maricopa.edu/non-discrimination.

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