Student’s Name:
High School:
Date of Birth:
Grade Level During Enrolled Term:
Anticipated Graduation Year:
> To be successful I must attend class, maintain communication with instructors and the high school guidance counselor. I
understand that the amount of work necessary to succeed in these courses may be much greater than in high school
courses. In addition, Dual Enrolled courses become a part of my permanent college transcript. It is important to do well
in these courses to realize all the benefits of the program. Dual Enrolled students are treated the same as any other
college student and are subject to all college policies governing students while attending classes offered by MTC.
> I understand that by becoming a Dual Enrolled student I must abide by the high school’s and the college’s rules and
regulations. As a dependent of my parent, I give MTC permission to release any information regarding my grades,
attendance, academic standing, disciplinary action, financial obligations, or any other aspect of my student life to my
parents or legal guardians. I also understand that grades, attendance, and any other academic information will be
provided to the high school as part of this agreement.
> I certify that the answers on this application are true, correct, and complete. I further certify that I will notify the
Admissions Office immediately if I change my state of legal residence or if my residency status otherwise changes. I
attest that I am a US citizen, a legal permanent resident in the United States, or an alien lawfully present in the US. I will
submit documentation to support this claim upon request. The South Carolina Illegal Immigration Reform Act (SC Code
Ann. 59-101-430 (Westlaw 2008)) prohibits those unlawfully present in the United States from attending a public
institution of higher education in South Carolina and from receiving a public higher education benefit. I understand that
submitting false or incorrect information may make me subject to dismissal from the college. Any student who is to be
unlawfully present in the US will be dismissed from the college.
> In the event that I incur a debt as a result of my attendance at the college, I understand any costs associated with
collections will be charged to me as the debtor.
Student’s Signature
click to sign
click to edit
Please indicate the appropriate level of permission below:
The above-named student has permission to enroll in any course that meets Dual Enrollment criteria provided that high school and
MTC prerequisites are met. Eligibility is determined through established MTC assessment metrics and the high school. Metrics
include qualifying SAT/PSAT, ACT/Pre-ACT, and/or ACCUPLACER Placement Test. Information on MTC assessment metrics and
qualifying scores can be found at
This student is using a 3.0 or higher High School GPA and/or class rank (top 25% of class) to establish eligibility for acceptance to
MTC in lieu of ACCUPLACER placement. Acceptance to MTC is based on demonstrated English proficiency. Math placement testing
may be required. Please note: the approval of the High School Principal (or designee) or Home School Association Director is
required to establish eligibility using the 3.0 or higher High School GPA
Does the student receive free or reduced lunch? Yes. No
9th and 10th Grade Students Only:
___ I affirm that the above student demonstrates exceptional ability:
> The student meets the College’s qualifying admission and placement metrics satisfactorily to take college level courses. The
student is enrolled in a college preparatory or higher curriculum at his or her high school or home school.
The student is in good standing and has no disciplinary problems at his or her school.
Principal or Designee (printed):
Signature and Date:
High School Comments:
> I understand that by allowing my child to participate in the Dual Enrollment program, I will be responsible for following
the guidelines and academic calendar of not only the high school, but also of the college.
> I hereby give my permission for my son/daughter, , to take Dual Enrolled courses
provided by Midlands Technical College.
> I will be responsible for any tuition and fees associated with courses taken on Midlands Technical College Campuses
> I understand that my student will be registered based on the information available to the College counselor at the time
of registration and that the student and his/her family are responsible for approving the courses my student enrolls in.
> I understand that it is our responsibility to determine the transferability of individual courses to colleges other than those
in the South Carolina Technical College system.
Parent or Legal Guardian Date
click to sign
click to edit