APPLICATION FOR DUAL ENROLLMENT/EARLY COLLEGE (386) 754-4300 phone or (386) 754-4800 Fax FLORIDA GATEWAY COLLEGE 149 S.E. COLLEGE PLACE LAKE CITY, FLORIDA 32025-2007 Welcome to Florida Gateway College! We are excited that you are considering the Dual Enrollment Program (DE). The Dual Enrollment Program is designed to be an acceleration mechanism for students desiring to earn both high school and college credit. The program is an excellent vehicle for students to gain college credit and experience while simultaneously completing requirements for high school. It is not uncommon for the typical dual enrollment student to earn several college credits by the time he/she graduates from their high school or home education program. To be considered for admission to the Dual Enrollment Program, the student must submit a completed Dual Enrollment application (with applicable test scores) while meeting the Florida Gateway College (FGC) admission application deadlines. Please check with your high school guidance counselor for specific information regarding admission application deadlines and/or see the College’s Academic Calendar (Critical Dates) publication on the college website http://www.fgc.edu. Note: Students attending public high schools that are enrolled in this program will have tuition, books and fees waived. Students attending nonpublic high schools or home education programs that are enrolled in this program will have tuition and fees waived, however textbooks are the responsibility of the student. APPLICATION PROCESS Please complete all sections of the Dual Enrollment Program application. Incomplete or unsigned applications cannot be processed. A. Public High Schools/Nonpublic High Schools 1. Dual Enrollment participation must be initiated through the high school guidance office. 2. The DE application must have the student signature, the parent or guardian signature, the school principal or designee signature, and the required college entrance test scores (scores older than two years are not accepted). 3. Return the completed DE application to your high school guidance counselor. The application will need to be processed by the FGC Dual Enrollment office. B. Home School Education Programs 1. Dual Enrollment participation must be initiated by the parent or guardian through the FGC Dual Enrollment office by providing proof that Home School Education meets Florida statutory guidelines from district school board. 2. The DE application must have the student signature, the parent or guardian signature, the school principal or designee signature, and the required college entrance test scores (scores older than two years are not accepted). 3. Make an appointment with the FGC Dual Enrollment office to submit the completed application and meet with the DE Advisor. Parent must execute the DE articulation agreement with FGC. Should you have any questions, please contact your high school guidance counselor and/or the FGC Dual Enrollment Staff Assistant at (386) 754-4341. We look forward to seeing you on campus! DUAL ENROLLMENT/EARLY ADMISSION APPLICATION FOR ADMISSION (386) 754-4300 (386) 754-4800 Fax NOTIFICATION OF SOCIAL SECURITY NUMBER COLLECTION AND USE: In compliance with and pursuant to Florida Statute 119.071 (5), 1008.386, 1002.22(2), and SBE Rule 6A – 1.0955 (3) (e), Florida Gateway College (FGC) issues this notification regarding the purpose of the collection and use of your Social Security number. FGC collects your Social Security number for use in performance of the college’s duties and responsibilities. In a seamless K-20 educational system, it is beneficial for postsecondary institutions to have access to the same information for purposes of tracking and assisting students in the transition from one educational level to the next. Federal legislation relating to the Hope Tax Credit requires that all postsecondary institutions report the Social Security number of all post-secondary students to the Internal Revenue Service (IRS). This IRS requirement makes it necessary for colleges to collect the Social Security number of every student. A student may refuse to disclose his/her Social Security number to the college, but refusing to comply with the federal requirement may result in fines established by the IRS. Providing your SSN on this form signifies that you consent to the use of your number in the manner described. To protect your identity, FGC will secure your Social Security number from unauthorized access. FGC will never release your Social Security number to unauthorized parties, and each student at FGC will be issued a unique student identification number. Your unique student identification number is used for all educational purposes at FGC including registration, access of your online record, etc. All Social Security numbers are protected by federal regulations and are never released to unauthorized parties. For additional detailed information on the college’s collection and use of social security numbers, please visit the college’s website at https://www.fgc.edu/current-students/registrar/right -to-know/ GENERAL INFORMATION 1. Have you previously attended Florida Gateway College? YES NO 2. Social Security Number: 3. FGC ID #: (for Admissions Office use only) 4. Legal Name: Last First Middle Preferred First Name: 5. Previous Name: Last First Middle 6. Permanent/Mailing Address: Street or P. O. Box City State/Zip County 7. Phone: Home Phone Cell Phone 8. Parent E-mail Address: 9. Emergency Contact Information: Name : Last First Phone Relationship to Student BIOGRAPHICAL/PERSONAL INFORMATION Disclosure of information collected in items 10-13 is not mandatory, however it is requested to aid the State of Florida in its commitment to Equal Educational and Employment Opportunity and to meet federal reporting requirements. This data may also be used in the awarding of scholarships. It is not used discriminatively for admission purposes. Refusal to answer the information requested in items 10-13 will not result in the adverse treatment of any applicant. 10. Gender/Sex: Male Female 11. Date of Birth: Month Day Year 12. Citizenship: U.S. Citizen Resident Alien Card #/Expiration Date: Other Please Specify: 13. A. Ethnicity: (check one): Hispanic or Latino Not Hispanic or Latino B. Race: (check one or more): American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White Student name: FGC ID#: Term: HIGH SCHOOL/FGC ENROLLMENT 14. High School: Grade you are in now: 15. Prior College Work/Attendance: Yes NO Month/Year of Anticipated Graduation: If yes, name of institution 16. FGC Entry Term: FALL (August) (Yr.); SPRING (January) (Yr.); SUMMER A (Yr.) SUMMER B (Yr.) SUMMER C (Yr.) 17. Enrollment Plans: / (Refer to FGC Dual Enrollment Programs of Study.) Program Name Program Code 18. Degree: (A.A., A.S., A.T.D., CER.) APPLICATION AGREEMENT We, student and parent (or guardian), agree to enroll in the Dual Enrollment/Early College Program at Florida Gateway College and certify the information on this application is accurate and complete. Based on the high school academic record and over-all maturity level of the student, we believe he/she will be successful in college level studies. We agree to abide by the guidelines of the Dual Enrollment/Early College Program, as well as the College policies and procedures while attending FGC. We understand all college grades become a permanent part of the student’s college record and we agree to the College’s release of information concerning any awards or academic honors the student might receive. Student Signature: Parent/Guardian Signature*: Date: *Note: An “Authorization to Disclose Information” must be completed and submitted to the Registrar’s Office in order to have access to any student information. This form is located at: www.fgc.edu under Current Students/ Forms/ Authorization to Disclose Information. Florida Gateway College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award the baccalaureate and associate degrees. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097, or call 404-679-4500 for questions about the accreditation of Florida Gateway College. The Commission is to be contacted only if there is evidence that appears to support an institution’s significant non-compliance with a requirement or standard. u FGC will adhere to all applicable federal, state, and local laws, regulations, and guidelines with respect to providing reasonable accommodations as required to afford equal educational opportunity. Students may obtain further assistance and information by calling Janice Irwin, coordinator of dis- ability services, at (386) 754-4215. The Disability Services Office is located in Building 017, Room 021, 149 SE College Place, Lake City, Florida 32025. u Florida Gateway College does not discriminate in education or employment related decisions on the basis of race, color, religion, national origin, gender, age, disability, marital status, genetic information, or any other legally protected status in accordance with the law. u The Equity Officer is Sharon Best, executive director of human resources, Building 001, Room 136, 149 SE College Place, Lake City, FL 32025, and may be reached at (386) 754-4313. EXCESS HOURS ADVISORY STATEMENT Section 1009.286, Florida Statutes, establishes an “excess hour” surcharge for a student seeking baccalaureate degree at state universities. It is critical that students, including those entering Florida College System institutions,