C OMPLETING THE FSCJ A PPLICATION H IGH S CHOOL A CCELERATION P ROGRAMS

I MPORTANT I NFORMATION TO N OTE  You are enrolling in _______ through Florida State College at Jacksonville  This course is for college credit and will reflect on your college transcript  Final course grades of W (withdrawal), D, F, or FN, are permanent parts of your college transcript and may negatively impact transfer to other colleges and universities, scholarships, and eligibility for Federal Financial Aid  We will complete the application together  MUST use black/blue ink to complete  Write CLEARLY  Applications are DUE to me with the residency portion completed and signed by your Parent/Guardian along with a Parent/Guardian signature on the Student Contract before or on _____________  You may not transfer this course to another DCPS high school

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only PART 1  Application Term  Fall Term  Select the appropriate status  Dual Enrollment (Traditional)  Returning DE Student  Where will you be taking the DE course  List the name of the high school that you will be taking the DE course, the city (Jacksonville), and your anticipated HS graduation date

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only  Personal Information  Use your legal name as listed on your schedule/report card  List Social Security Number  Social Security numbers MUST be included for all applicants; If you are not 100% sure of your SS#, leave it blank  List your best contact number  address listed in this section should be an address that can be regularly accessed

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only  Personal Information  Fill in your date of birth and age  Bubble in your gender  Enter your country of birth (i.e.. United States)  Bubble in your primary language (i.e. English, Spanish, or Other)  Fill in your Parent/Guardian as your Emergency Contact and their phone number(s)  The information in the box is optional, you do not have to complete it if you do not wish to do so

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION DO NOT COMPLETE THIS SECTION DO NOT WRITE IN THIS SECTION!

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only  High School Personal Authorization  Complete all sections with the appropriate information  Your Name  High School  County - Duval  Student’s Authorized Term Registration  SKIP THIS SECTION This section will be completed by your counselor

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only  Student Agreement  Read the student agreement and sign (in cursive) and date  Parent/Guardian Agreement & Residency  Fill in your name  Your PARENT will need to complete the date they became a Florida resident  If they have lived in FL since birth, then the date entered should be their date of birth  Have your parent sign and enter their phone number and address YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT THIS INFORMATION!

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only STUDENT CONTRACT  Read each portion of the contract carefully.  Expectations  Program Level Requirements  Print your name, birth date, sign (cursive), and date  Have your parent or guardian sign and date

C OMPLETING Y OUR D UAL E NROLLMENT A PPLICATION complete using black/blue ink only  Missing Safety and Security Information  Every student enrolled in a course via FSCJ (on campus, online, or at their local high school) must complete the security agreement

R EMINDERS  You are enrolling in _______ through Florida State College at Jacksonville  This course is for college credit and will reflect on your college transcript  Final course grades of W (withdrawal), D, F, or FN, are permanent parts of your college transcript and may negatively impact transfer to other colleges and universities, scholarships, and eligibility for Federal Financial Aid  Applications are DUE back to me with the residency portion completed by your parent/guardian, signed on that page and on the Student Contract page before or on _____________  You may not transfer this course to another DCPS high school