Dual Enrollment Application

Dual Enrollment Application Alcoa High School 2016-2017 Student’s Full Name: ______Student’s Email Address: ______Eligibility for Participation in Dual Enrollment (DE):  Minimum ACT sub-scores of 19 in Reading, 18 in English, and 19-26 in Math (for math classes only), depending on the math class  Minimum of 3.0 cumulative, unweighted GPA  Complete admissions requirements to DE institution of choice  Complete TSAC DE Grant application  Maintain a 2.75 GPA in all college courses attempted  Arrange for transportation to and from DE institution  Turn in all paperwork on time Name of DE Institution (circle one): Pellissippi State (PSCC) Maryville College Course(s) to be taken (include days & times of courses): Fall Spring 1. ______

1. ______

2. ______

3. ______

4. ______

5. Example: English 1010, MWF at 8:00-8:50

5. Example: Psychology, TTh at 9:00-10:30

1 Please verify the following information by checking the box below:  I have the minimum ACT or PLAN requirements for the above courses.

 I have at least a 3.0 unweighted GPA.

Student Responsibilities (initial in the space provided once completed): ___ 1. Complete an application for admission to the college you plan to attend for DE. In order to be a DE college student, YOU MUST APPLY TO THE DE INSTITUTION! A. You can apply to PSCC by going to the following website: www.pstcc.edu/dual and click the “Apply to PSCC” link. There is no application fee for PSCC, but you must complete the Hepatitis B Immunization form, found on the website listed above. This must be signed by parents and returned directly to PSCC. B. You can apply to Maryville College by going to the following website: http://www.maryvillecollege.edu/admissions/apply/dual-enrollment and click the “Begin Dual-Enroll Application” link. There is an application fee, which must be paid to the college during the application process. ___ 2. Submit a Transcript Request Form to Ms. White in Student Affairs for the DE institution you plan to attend.

___ 3. Complete the TSAC Dual Enrollment Grant for both semesters (fall and spring) by going to the following website: https://clipslink.guarantorsolutions.com/StudentSignon/Registration.aspx

___ 4. Register for classes after you receive your acceptance into the DE institution.

___ 5. If you need to drop a class, you must notify PSCC or other DE institution directly. Upon verification of withdrawal, you need to meet with your School Counselor for confirmation and a schedule change.

___ 6. Have your parent/guardian sign the Permission to Leave Campus Form attached to this application.

___ 7. Complete this Dual Enrollment Application and return to your School Counselor.

My signature below indicates that I have successfully completed all of the student responsibilities listed above. I understand that I will not be allowed to participate in DE until the Permission to Leave Campus Form has been signed by my parent and returned to the Student Affairs Office.

2 ______

Student Signature Date Parent/Guardian Signature Date