Fillable APPLICATION FOR THE HIGH SCHOOL ENRICHMENT PROGRAM (Community College of Rhode Island)

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APPLICATION FOR THE HIGH SCHOOL ENRICHMENT PROGRAM (Community College of Rhode Island)

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The APPLICATION FOR THE HIGH SCHOOL ENRICHMENT PROGRAM (Community College of Rhode Island) form is 3 pages long and contains:

  • 4 signatures
  • 8 check-boxes
  • 80 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Community College of Rhode Island

BROWSE COMMUNITY COLLEGE OF RHODE ISLAND FORMS

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APPLICATION FOR THE HIGH SCHOOL ENRICHMENT PROGRAM
Please print clearly.
Previous name
Permanent home street address
Are you a U.S. citizen?
Yes
No
If you are not a U.S. citizen, do you have a Permanent Resident Card (Green Card)?
Yes
No
If you are a permanent resident card holder, please provide your alien registration number.: _____________________________________________________
Have you lived continuously in Rhode Island for one or more years as of the rst day of classes for this semester?
Yes
No
Is Rhode Island your legal and permanent state of residence?
Yes
No
If you have a non-Rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all
required documentation. This information is available at wwww.ccri.edu/oes/admissions/pdfs/resusperm.pdf
If you are not a legal and permanent resident of Rhode Island, please list your legal residence.
Street
_______________________________________________________City _________________________________________State _______ ZIP _____________ Country____________________________
Are you a recipient of the Supplemental Nutrition Assistance Program (SNAP)?
Yes
No
Service members or dependents
Did you serve or are you serving in the U.S. armed forces?
Yes
No
N/A
If you or your dependents are currently serving, are you stationed in Rhode Island on active duty?
Yes
No
N/A
Will you be using VA education benets at CCRI?
Yes
No
N/A
Will you be using VA education benets as a dependent at CCRI?
Yes
No
N/A
Did you honorably serve in a combat zone?
Yes
No
N/A
Please note:
• Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status.
• Other visa or immigration status: Please mail a copy of your Visa, I-797 or other documentation.
Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will rem
ain liable for all tuition and fees.
Date of birth (mm/dd/yy)
Home telephone number
Social Security number
Gender
:
Cell number
Please text me important college information regarding enrollment,
nancial aid and other key milestones in my academic progress
Date of application
City
(as it appears on Social Security card or U.S. passport)
Email address
State/Zip
Last name
First name
Middle initial
Middle initial
For Oce Use
CCRI ID Number: For Oce Use
Social Security number is mandatory under federal law. If applying without a social
security number see http://www.ccri.edu/oes/admissions/applicantwithoutssnortin.html
Yes
No
The High School Enrichment Program at the Community College of Rhode Island offers high school juniors and seniors an
opportunity to pursue post-secondary educational experiences. It is a part-time program, whereby high school students
may enroll in up to six (6) credits (or two courses) per semester: Qualified students may enroll full time in the Running
Start Program. Information about the Running Start Program is available at www.ccri.edu/oes/admissions/partnerships/
runningstart.html.
Course selection is made at the discretion of the high school guidance counselor. Students are required to complete this
High School Enrichment application with the consent and advice of a parent/guardian, school counselor or school principal.
Home-schooled students must have the application signed by their respective superintendent of schools. The student and
parent/guardian should then bring the completed application with the selected courses to the CCRI Office of Enrollment
Services to register. Registration may be contingent upon course availability, instructor agreement and prerequisite
requirements.
For information about the “Prepare RI” dual and concurrent enrollment funding, please see www.RIDE.ri.gov.
Program description
Name __________________________________________________ Student ID number ___________________________________________
Date ____________________ Semester ______________________ Expected year of graduation ____________________________________
High school name ________________________________________ High school grade ____________________________________________
School counselor name ____________________________________ Telephone _________________________________________________
(Please visit www.ccri.edu/catalog to determine if ACCUPLACER placement testing is required.)
Courses (Maximum of two courses per semester. Courses must be selected by your school counselor.)
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Other course options approved by the high school (See school counselor.)
Secondary school ofcial ________________________________________________________________________________________________
(Superintendent, principal or school counselor)
CCRI representative ___________________________________________________________________________________________________
Name Title
Authorization to release records by signing this application.
I authorize the Community College of Rhode Island to release all education records (records include transcripts, semester course schedule, assessment test
scores and residency information) to my high school counselor or his/her designee, my parent/guardian(s), the Rhode Island Department of Education and
the RI Ofce of the Postsecondary Commissioner during my enrollment in dual enrollment courses at CCRI.
I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and
regulations at, and fulll all nancial obligations to, the Community College of Rhode Island.
Agreements:
CCRI APPLICATION 04/2020
Applicant's signature Application date
If under age 18, signature of parent/guardian Application date
The following information helps us comply with federal statistical reporting requirements only and will not, in any way, impact an admission
decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories.
Ethnicity: (Not used for admission. Please check one.)*
Not Hispanic
Hispanic or Latino
Federal regulations require colleges
to report enrollment data by racial, ethnic
and gender categories
Race: (Not used for admission). Not Hispanic or Latino.
American Indian or Alaska Native
Asian
Black or African American
Important information:
One or both parents (biological or adoptive) earned a four-year degree
Single parent with custody of a child under 18
Speaker of English as a second language
Displaced homemaker
†
* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education
reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports.
†
The term displaced homemaker refers to women or men who have worked mainly in the home for a minimum of two years caring for home and family. Due to loss of family nancial
support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families.
Yes
No
Yes
No
Yes
No
Yes
No
Native Hawaiian or other Pacific Islander
White
Two or more races
Required signatures
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AU
THORIZATION TO RELEASE ACADEMIC RECORDS
Of Students Participating in Dual Enrollment
FE
RPA Release Form (Family Educational Rights and Privacy Act)
Fo
r students participating in dual or concurrent enrollment courses at CCRI, RIC, or URI.
I, _________
________________________________________________________, hereby authorize the
Print Full Name
Com
munity College of Rhode Island (CCRI), Rhode Island College (RIC), the University of Rhode Island (URI)
Circle the institutions where you will take concurrent or dual enrollment classes this semester.
to
release all education records (including transcripts, semester course schedule, assessment test scores, satisfactory
academic progress status and residency information) to my high school counselor or his/her designee, my
parent/guardian(s), the Rhode Island Department of Education and the RI Office of the Postsecondary
Commissioner during my enrollment in dual enrollment courses, for the purposes of jointly gaining secondary
school and college credit.
I al
so understand this release remains in effect for one calendar year from the date it is received by CCRI, RIC or
URI, unless I revoke my consent in writing and deliver it to the Office of Enrollment Services at CCRI, the
Records Office at RIC, or the Enrollment Services Office at URI.
Initial I worked with my secondary school guidance counselor or school
administrator to
choose my selected dual/concurrent enrollment courses as part of my high school credits.
Hi
gh School _____________________________________________________________________________
St
udent’s Signature _____________________________________________ Date _______________________
Parent’s Signature: ________________________________________________________________________
If student is younger than 18, parent/guardian signature is req
uired.
Office of Enrollment Services
Knight Campus, 400 East Ave., Warwick, RI 02886-1807, 401-825-2003
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APPLICATION FOR THE HIGH SCHOOL ENRICHMENT PROGRAM (Community College of Rhode Island)

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Completed 16 March 2022

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