2016 COLORADO COLLEGE SUMMER SESSION

PRE-COLLEGECOURSE APPLICATION

Admission to the Colorado College Summer Session Pre-College program requires applicants to complete this form. Form may be filled out and submitted to . Alternatively, mail this completed and signed form along with all the other required documents to: Colorado College, Pre-college program, Summer Session Office, 14 E. Cache La Poudre, Colorado Springs, CO, 80903. See checklist on page two for a complete list of all items to include with your application.Only students who will be seniors during the 2016 fall semestermay apply for scholarship and meritawards using the form found on the Summer Session website.

Please type or print. To fill out online, click in gray boxes and type. Fields will expand as needed.

APPLICANT’S NAME and PERSONAL DATA:

This fall, I will be a high school Junior Senior / Other – please explain:
Last (family name): / First: / Middle: / Gender:
Date of Birth (required for admission and transcripts): / Place of Birth (required for admission and transcripts):
Ethnicity: (Check one or more that describe your background.)
American Indian or Alaska Native (including all Original People of the Americas)
Asian (including Indian subcontinent and Philippines)
Black or African American (including Africa and Caribbean) / Hispanic or Latino (including Spain)
Native Hawaiian or Other Pacific Islander (Original Peoples)
White (including Middle Eastern)

APPLICANT’S CURRENT MAILING ADDRESS:

Street and number: / City:
State/Province: / Zip/Postal Code: / Country (if other than US):
Expiration for this address: / Cell Phone: / Cell valid through summer? Yes No
Email Address: / Expiration for this address:

APPLICANT’S PERMANENT MAILING ADDRESS (if different from above):

Street and number: / City:
State/Province: / Zip/Postal Code: / Country (if other than US):
Please indicate the best way to reach you: E-mail Phone Current Mailing Address Permanent Mailing Address

PARENT CONTACT INFORMATION:

Parent 1 - Name: / Parent 2 - Name:
Address-(if different from above)Street and number:
City: State: Zip: / Address-(if different from above):Street and number:
City: State: Zip:
Primary phone: Secondary phone: / Primary phone: Secondary phone:
Email: / Email:

EMERGENCY CONTACT: (PLEASE PROVIDE CONTACT INFORMATION FOR SOMEONE OTHER THAN A PARENT)

Name: / Relationship to student: / Primary Phone:
Street Address: / City: / Secondary Phone:
State/Province: / Zip/Postal Code: / Country (if other than US):

BILLING PARTY INFORMATION:

Last Name: / First Name / Middle name:
Street Address: / City: / State/Province:
Zip/Postal Code: / Country (if other than US):

SCHOOL INFORMATION:

Name of Current School: / Expected Date of Graduation: / GPA: / Rank
Are you in good standing at your current school? Yes No
If No, please attach a letter with explanation. / Who drove the decision to apply for Colorado College Summer Session?
I did my parents both Other:

Please select which pre-college program you are applying for:

Regular Block A and/or B courses (Option 1)

Pre-College only Block course (Option 2)

OPTION 1: REGULAR BLOCK COURSES: PLEASE LIST THE COURSES YOU WISH TO TAKE THIS SUMMER: Students can enroll in only one course per block.

Course choices / CRN # / COURSE # / COURSE TITLE / GRADE TRACK* / INSTRUCTOR / UNITS
Block A
Block A
2nd Choice
and or
Block B
Block B
2nd Choice

OPTION 2: PRE-COLLEGE PROGRAM BLOCK COURSE(S):

PLEASE SELECT ONE OF THE FOUR MAIN COURSES, AND THE OPTIONAL COLLIGIEATE COMMUNICAITONS COURSE, IF DESIRED.

Course choices / CRN # / COURSE # / COURSE TITLE / GRADE TRACK* / INSTRUCTOR / CC UNITS
(SH = semester hours)
30093 / EN 104 / Cross Genre Writing Workshop / Goodwin and Hayward / .75 (3 SH)
30094 / EV 100 / From Grassland to Glacier / Mike Taber / .75 (3 SH)
30096 / .PS 102 / Freedom and Empires: The Drama of Ancient Politics / John Grace / .75 (3 SH)
30095 / SO 102 / Communities and Networks / Kathy Giuffre / .75 (3 SH)
The following course is MANDATORY FOR INTERNATIONAL STUDENTS.
It is OPTIONAL FOR DOMESTIC STUDENTS.
30097 / GS 103 / Communications for Collegiate Success / Julian Plaza / .25 (1 SH)

*Grade Track: P=Pass/Fail (S, CR, NC) G = Grade (A, A-, B+, B, B-, C+, C, C-, D, NC) (Grade track changes may be made only during the first four days of class)

Applications will be reviewed on a rolling basis. You will receive notification of acceptance within two weeks of receipt of completed application. Course schedules and additional information will be sent separately.

Course deposits ensure a place in a desired course and go toward tuition. Tuition for summer 2016 is $4000 per unit.

$500 for each 1 or 2 unit course...... $ + Application fee $50.00

= total charge....$

Financial Obligation:

I accept responsibility for financial charges (e.g. tuition, course fees and collection costs if delinquent) associated with pre-registering for a Colorado College summer session course(s) and understand and agree with the refund policy and withdrawal procedures. (A detailed explanation of course withdrawal and refunds is available at

I have read and agree to potential financial charges as indicated above, per my typed signature as financially responsible party.
Signature of Financially Responsible Party:
(must be parent or legal guardian if applicant is under 18 years of age)
CHECK / Please send two separate checks, payable to Colorado College,
One for application fee and one for course deposit(s). / Check 1: Application Fee - $50
Check 2: Deposit fee of $500 per unit
CREDIT CARD / Call 719-389-6655 with credit card information.
Applicant’s admission checklist: / How did you first find out about Colorado College Summer Session?
Application
Transcript(s)
Teacher Report
Counselor Report
Housing application / Colorado College website
Google Ad
Facebook Ad
C.C. alumnus/alumna
Campus Tour / Direct email from CC
Teacher/faculty member
School counselor
Parent
Other family member / High school fair
TheEducationalRegister.com
USummer.com
Printed ad, where?
Other:

For office use only: