Reset
REQUEST FOR HIGH SCHOOL EARLY ADMISSION/DUAL CREDIT PROGRAM
EARLY ADMISSION (EA)LVWKHDWWHQGDQFHRIKLJKVFKRROVWXGHQWVLQFROOHJHFRXUVHVSULRUWRJUDGXDWLRQIURPKLJKVFKRRO(DUO\$GPLVVLRQVVWXGHQWV UHFHLYHFROOHJHOHYHO
DFDGHPLFFUHGLWRQO\IRUFRXUVHVWDNHQDW(3&&&RXUVHVPD\EHWDNHQGXULQJGD\HYHQLQJDQGZHHNHQGKRXUV6WXGHQWVDUHQRWHOLJLEOHIRUILQDQFLDODLG
HIGH SCHOOL DUAL CREDIT PROGRAM (DC)LVDSURFHVVE\ZKLFKDQHDUO\DGPLVVLRQVWXGHQWHQUROOVLQD&ROOHJHOHYHOFRXUVHDQGUHFHLYHVVLPXOWDQHRXVDFDGHPLF
FUHGLWIRUWKHFRXUVHIURPERWKWKHFROOHJHDQGWKHKLJKVFKRRO$IRUPDOSURJUDPDJUHHPHQWEHWZHHQ(3&&DQGKLJKVFKRROPXVWH[LVWIRUGXDOFUHGLW&RXUVHV IRUGXDOFUHGLW
PXVWEHWDNHQGXULQJWKHUHJXODUKLJKVFKRRODWWHQGDQFHKRXUV6WXGHQWVDUHQRWHOLJLEOHIRUILQDQFLDODLG
Eligibility Requirements:
0XVWEHFODVVLILHGDVDhigh school student
0XVWPHHWDFDGHPLFSODFHPHQWDVVHVVPHQWUHTXLUHPHQWVLQDWOHDVWRQHDUHDRIPDWKHPDWLFVUHDGLQJDQGZULWLQJVWXGHQWVPD\RQO\HQUROOLQFRXUVHVUHODWLQJWRDUHDVRIWKH
WHVWLQZKLFKWKH\SODFHLQWRFROOHJHOHYHOFUHGLWFRXUVHV
TO BE COMPLETED BY HIGH SCHOOL PRINCIPAL
,KDYHUHYLHZHGWKLVDSSOLFDQW
VKLJKVFKRROUHFRUGDQG,UHFRPPHQGDFFHSWDQFHLQWRWKH+LJK6FKRRO(DUO\$GPLVVLRQ'XDO&UHGLW
3URJUDPEHJLQQLQJ
Fall
Spring
6,*1$785(2)+,*+6&+22/35,1&,3$/
Semester
Year
NAME (printed/typed)
DATE
TEL #
To be completed by student and Parent/Legal Guardian
LAST NAME
FIRST NAME
MI
Wη
DATE OF BIRTH
ADDRESS
CITY
STATE
ZIP
TEL #
+,*+6&+22/
&,7<
67$7(
=,3
*5$'8$7,21'$7(
,IDGPLWWHG,ZLOODGKHUHWRWKHSROLFLHVDQGSURFHGXUHVRIWKHFROOHJH,XQGHUVWDQGWKDWLI,HQUROOLQANY DEVELOPMENTAL COURSE(SRUDQ\FRXUVHVQRWDXWKRUL]HG
,ZLOOEHDGPLQLVWUDWLYHO\ZLWKGUDZQIURPWKRVHFRXUVHVZLWKUHIXQG1RQILOWHUHGFRPSXWHUWHFKQRORJ\LVXVHGLQGXDOFUHGLWDQGFROOHJHOHYHOFODVVHVDQGOLEUDULHV6WXGHQW
LPDJHVDUHWUDQVPLWWHGWRRWKHUORFDWLRQVLQ'LVWDQFH/HDUQLQJFODVVHV0\VLJQDWXUHDXWKRUL]HVWKHUHOHDVHRIP\SODFHPHQWDVVHVVPHQWWHVWVFRUHVDQGFRXUVHJUDGHVVFRUHV
DQGSURJUHVVUHSRUWVWRP\KLJKVFKRROIRUGXDOFUHGLWFRXUVHV$FNQRZOHGJHPHQWRIWKLVLQIRUPDWLRQLVUHTXLUHGWRSDUWLFLSDWHLQWKH'XDO&UHGLW3URJUDPDQGRU(DUO\$GPLVVLRQ
Request EPCC to release your directory information? Yes___ No___
6,*1$785(2)3$5(1725*8$5',$1
6,*1$785(2)678'(17
DATE
'$7(
ADMISSIONS OFFICE USE:
Admitted
Updated on system: Not Admitted
Transcript received or on file
Initials
(O3DVR&RXQW\&RPPXQLW\&ROOHJH'LVWULFWGRHVQRWWRGLVFULPLQDWHRQWKHEDVLVRIUDFHFRORUQDWLRQDORULJLQUHOLJLRQJHQGHUDJHGLVDELOLW\YHWHUDQVWDWXVVH[XDORULHQWDWLRQ
RUJHQGHULGHQWLW\