ALABAMA SOUTHERN
COMMUNITY COLLEGE
APPLICATION FOR ADMISSION
DUAL ENROLLMENT/DUAL CREDIT PROGRAM
Alabama Southern Community College / Application for Admission –Dual Enrollment/Dual Credit Program
Mail to Admissions Office, Alabama Southern Community CollegeP. O. Box 2000, Monroeville, AL 36461
Application For:Year______New Applicant
Fall _____Spring _____ Summer ______Readmission Applicant
PERSONAL INFORMATION
Birth Date ______/______/______
Month Day YearSocial Security Number ______
______/______/______
Last Name First Name/Middle Initial Former or Maiden Name
Gender and ethnic information is requested solely for reports required by state and federal courts and other authorities and will not be used in any manner to determine admission to Alabama Southern Community College.
Gender:Ethnic Origin:
______Male______White/Non-Hispanic______Black/Non-Hispanic
______Female______Hispanic______American Indian/Alaskan Native
______Asian/Pacific Islander______International
RESIDENCY INFORMATION
Mailing Address: ______/______/______/______/______
Street CityState Zip County
Home phone (______)______Work phone (______)______
______U.S. Citizen______Permanent resident
I have read the guidelines for In-State Residency Certification. Based on these guidelines, I certify that I am a resident of Alabama.
______Yes______NoIf no, please list state of legal residency ______
EDUCATIONAL BACKGROUND
Has either of your parents or legal guardian graduated from a four-year college?______Yes______No
Expected date of high school graduation ______
______/______/______/______
Name of High School Address City State
Your name on high school transcript ______/______/______
CERTIFICATION
I have informed my parent/guardian of my participation in the Dual Enrollment/Dual Credit program at Alabama Southern Community College, and I authorize Alabama Southern Community College to release my academic record to my high school. I certify the statements on this application are true and complete to the best of my knowledge. I understand that falsification of information on this application could result in dismissal or other disciplinary action.
Signature ______Date ______
Alabama Southern Community College provides equal opportunity to and is open and accessible to all qualified students without regard to race, color, creed, national origin, gender, or qualified disability, with respect to all of its programs, activities, or employment.
Alabama Southern Community College
High School Authorization Form
Dual Enrollment/Dual Credit Plan
This form is to be used by high school students who are applying for Dual Enrollment/Dual Credit in area school systems and Alabama Southern Community College (ASCC).
Eligible students are permitted to enroll in college courses conducted during school hours, after school hours and during summer terms. Courses offered shall be drawn from ASCC’s existing academic inventory of courses for credit. Courses numbered below 100 and physical education courses are not eligible under this plan. ASCC reserves the right to cancel course offerings when courses do not meet minimum enrollment requirements.
To be eligible for dual enrollment each student must meet the following criteria:
- Meet the entrance requirements established by Alabama Southern Community College;
- Have a “B” average in completed high school courses;
- Have written approval of the appropriate principal and the local superintendent of education;
- Be in grades 10, 11, or 12, or have an exception granted by ASCC upon the recommendation of the student’s principal and superintendent and in accordance with Alabama Administrative Code 290-8.9.17 regarding gifted and talented students;
- Students who are enrolled in grades 10, 11, or 12 may be deemed eligible to participate in dual credit/dual enrollment in occupational/technical courses pending demonstrated ability to benefit as documented by successful completion and placement by ASSET, WorkKeys, CPAT, or other assessments approved by the Department of Postsecondary Education. Students enrolled under the ability-to-benefit provision must have a “B” (3.0 grade point average) in high school courses directly related to the occupational/technical studies (if applicable), which the student intends to pursue at the postsecondary level and an overall 2.5 grade point average in high school course work. Exceptions may be made on an individual student basis after assessment and with the mutual consent of both the School Board and the College.
Student Request
______, a student enrolled at ______High School, in the ______school system, requests permission to enroll in the Dual Enrollment/Dual Credit program for the ______quarter/semester, ______(year).
ASCC Course(s) Requested / Hours Credit / High School Course Equivalent / Unit Credit______
Signature of StudentSignature of Parent/Guardian
Certification
I hereby certify that ______, a student enrolled at ______High School, is currently classified as a high school ______, and meets all Dual Enrollment/Dual Credit eligibility requirements as set out by the Alabama State Board of Education, the ______School Board, and ______High School. I request that ______be approved for Dual Enrollment/Dual Credit.
This the ______day of ______, ______.
______
Superintendent (type or print)Superintendent (signature)
______
Principal (type or print)Principal (signature)
______
Counselor (type or print)Counselor (signature)
NOTE: Available only to school systems that have entered into a Dual Enrollment/Dual Credit contract agreement with Alabama Southern Community College.
Alabama Southern Community College
Application for Admission – Dual Enrollment/Dual Credit
Eligibility for In-State Residency Certification
Students who meet one of the following requirements below qualify for in-state tuition.
I (or my non-estranged spouse) have lived in the state of Alabama for at least 12 months.
I am a minor, and my parent(s)/legal guardian(s) have lived in the state of Alabama for at least 12 months.
Students who cannot satisfy one of the requirements listed above are considered non-residents of the state of Alabama. Students meeting one of the following requirements must submit a Certification of Eligibility for In-State Residency Form. Appropriate documentation must be provided in support of the request for eligibility for resident tuition rates. Students should notify the college if there are any changes in residency status. Out-of-state students cannot attain resident student status simply by attending school for 12 months in the state of Alabama.
I am a non-resident dependent student, and my supporting person is a full-time permanent employee of this institution.
I am a non-resident dependent student, and my support person can verify full-time permanent employment in Alabama, and said employment will begin within ninety (90) days of my registration.
I am a non-resident dependent student, and my supporting person is a member of the United States military on full-time active duty stationed in Alabama under orders for duties other than attending school.
I am a non-resident dependent student, and my supporting person is an accredited member of a consular staff assigned to duties in Alabama.
I (or my spouse) am a full-time permanent employee of this institution.
I (or my spouse) can verify full-time permanent employment in Alabama, and said employment will begin within ninety (90) days of my registration.
I (or my spouse) am a member of the United States military on full-time active duty stationed in Alabama under orders for duties other than attending school
I (or my spouse) am an accredited member of a consular staff assigned to duties in Alabama.
I reside in a county of a state, which is within the 50-mile radius of the designated campus of this institution.
Directory Information
Alabama Southern Community College considers a student’s name, dates of attendance, and degrees awarded as public information and available for disclosure without a student’s written consent. Students who do not want any public or directory information released to representatives independent of the college should sign below.
______
Signature of StudentDate