Fillable Application Checklist (North Shore Community College)

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Application Checklist (North Shore Community College)

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Dual Enrollment
Application Checklist
Step 1:
Complete NSCC’s Computerized Placement Test (Accuplacer)
unless proficiency can be met by P/SAT/ACT scores:
(P/SAT scores : 550 in Reading & Writing, 540 in Math;
ACT scores: 22 in Reading, Writing and Math)
- No appointment is necessary; test is given on a walk-in basis.
- For more information and oce hours, contact the hotline at
978-762-4000 x4376 or on the web at northshore.edu/cas
Step 2
Choose your course: Search for current course oerings (including
descriptions, times, locations) from the main page of the
NSCC website: northshore.edu
Step 3
Complete the Dual Enrollment Application; be sure to include:
Parent signature, if under 18 years of age
Guidance Counselor signature
Copies of Accuplacer/CPT or SAT/ACT scores.
Copy of high school transcript.
In-State tuition form (mandatory).
Step 4
Submit the completed application to the Enrollment Center
for course registration.
Danvers Campus,
One Ferncroft Rd, Health Professions Building, Room 260
Lynn Campus,
300 Broad Street, Room LS134
Documents can also be submitted by mail to:
North Shore Community College
Enrollment & Student Records
1 Ferncroft Rd, Danvers, MA 01923
Step 5
Set-up Pipeline account, activate North Shore email account.
THE DUAL ENROLLMENT PROGRAM at
North Shore Community College provides
an opportunity for high school or
home- schooled students to take college
courses. Students may choose to do so to
finish requirements for a high school
diploma or for personal enrichment
purposes.
Students should work with their guidance
counselors to determine course selection
based on the student’s academic skill level
and educational goals. Academic and
student support services, including
academic advising, career counseling, free
tutoring, computer labs, and library access
are provided to maximize success.
Students are eligible to obtain a student
ID and participate in NSCC-sponsored
activities and clubs.
College level courses taken at NSCC may
be transferred to a 4-year college or
university. The MassTransfer Program
provides a great opportunity to gain
admission to participating colleges
or universities. Please refer to the link for
more information:
www.mass.edu/masstransfer
North Shore Community College is
responsive to the needs of students with
disabilities. We have a simple procedure
for students who would like to request
services and establish eligibility for
academic accommodations. There are
many academic support options for
qualified students. Please visit our web
site for more information:
northshore.edu/accessibility
FOR MORE INFORMATION
Please call Susan Curry, Director of Early
College Partnerships, 978-739-5521.
Questions can also be emailed to
scurry@northshore.edu
4/25/19
North Shore Community College
Dual Enrollment
APPLICATION CHECKLIST
MAILING ADDRESS
North Shore Community College
Dual Enrollment
1 Ferncroft Road, Danvers, MA 01923
northshore.edu/early-college
earlycollege@northshore.edu
4/25/19
PLEASE SELECT A TERM
FALL WINTER/SPRING SUMMER YEAR _________
North Shore Community College
Dual Enrollment
APPLICATION
MAILING ADDRESS
North Shore Community College
Dual Enrollment
1 Ferncroft Road, Danvers, MA 01923
northshore.edu/early-college
earlycollege@northshore.edu
LEGAL LAST NAME
LEGAL FIRST NAME
DATE OF BIRTH
PREFERRED NAME
HIGH SCHOOL / YEAR OF GRADUATION
MIDDLE NAME
ADDRESS
CITY STATE ZIP
SSN GENDER: _____________________
MONTH DAY YEAR
HOME PHONE CELL PHONE
EMAIL ADDRESS (please print neatly)
• HAVE YOU COMPLETED AN NSCC OR OTHER COLLEGE COURSE(S)? YES NO
• HAS EITHER PARENT GRADUATED FROM A 4-YEAR COLLEGE?
YES NO
• ETHNICITY INFORMATION: Optional
ARE YOU HISPANIC/LATINO?
YES NO
ARE YOU: Please check any that apply.
AMERICAN INDIAN OR ALASKA NATIVE ASIAN BLACK OR AFRICAN-AMERICAN
CAPE VERDEAN WHITE NATIVE HAWAIIAN OR PACIFIC ISLANDER
1. COURSE CHOICES
Please note: Accessibility services are available to students that have documented disablities through the College’s Accessibility Services Oce. It is important to note that academic accomodations available at the college level
dier from those available at the high school level. For additional information regarding the services available, visit Disability Services at northshore.edu/accessibility
CRN COURSE CODE COURSE TITLE CREDITS
1ST CHOICE
2ND CHOICE
2. STUDENT SIGNATURE
If accepted to the Early College Dual Enrollment Program at North Shore Community College, I agree to adhere to the North Shore Community College
code of Student Conduct as outlined in the NSCC Student Handbook found at
northshore.smartcatalogiq.com/en/current/Credit-Catalog/Student-Handbook
I hereby authorize the release of my academic and student records by North Shore Community College for legitimate educational purposes.
I understand that if I do not authorize the release of my academic and student records, it is my responsibility to obtain copies of my NSCC /
Dual Enrollment academic transcript for my high school records.
I understand that if I withdraw from a course after the ocial add/drop period, there will be consequences to my academic record.
I certify that all information stated on this application is accurate and complete.
STUDENT SIGNATURE _______________________________________________________________________________________________________ DATE _________________________________________
3. PARENT/GUARDIAN SIGNATURE:
I hereby grant permission for my child to apply to the Dual Enrollment Program at North Shore
Community College. I understand that as a participant in the Dual Enrollment Program, it is my child’s responsibility to obtain copies of his/her
NSCC academic transcript, or authorize release of the information, for inclusion in his/her high school records. Required if student is under 18 years of age.
PARENT/GUARDIAN SIGNATURE_____________________________________________________________________________________________ DATE _________________________________________
TELEPHONE _________________________________________________________________ EMAIL ________________________________________ ______________________________________________
4. GUIDANCE COUNSELOR SIGNATURE (Please note, this application requires student transcript)
I acknowledge student is taking an NSCC Early College Dual Enrollment course.
GUIDANCE COUNSELOR SIGNATURE _________________________________________________________________________________________ DATE _________________________________________
STUDENT SASID (REQUIRED) TRANSCRIPT ATTACHED
5/12/20
Lab fee for Science course + $45.00 / lab science course
NSCC Facility fee + $50.00
WAIVE MASSPirg donation + $9.00
TOTAL COST $
2. PAYMENT INFORMATION
Include a check or money order for total amount due payable to NSCC.
If you would like to use mastercard/visa/discover, fill in all credit card information. (required for fax-in registrations.)
MASTERCARD
VISA
DISCOVER
ACCOUNT #

–

–

–

EXP DATE (MONTH/YEAR)

/

CVV CODE

CARD HOLDER'S SIGNATURE _____________________________________________________________________
TUITION
Students and/or parents are responsible for the costs of tuition, fees and books. High school students are not eligible for Financial Aid.
Payment can be made in one lump sum or in installments. The cost of tuition and fees varies by semester and can be found on the web
at
northshore.edu/paying/cost
1. COURSE COSTS
Credit course cost is $219 per credit.
The Board of Trustees reserves the right to increase tuition and fees without prior notice.
COURSE TITLE CREDITS COST
X $223
X $223
X $223
North Shore Community College
Dual Enrollment
COST WORKSHEET
MAILING ADDRESS
North Shore Community College
Dual Enrollment
1 Ferncroft Road, Danvers, MA 01923
northshore.edu/early-college
earlycollege@northshore.edu
0
0
0
Massachusetts Community Colleges
In-State Tuition Eligibility Form
For ocial use. Do not write in this box.
I have reviewed the above information in order to determine applicant’s eligibility to receive the in-state tuition rate.
Based on my review I have determined this applicant:
_____ IS eligible for the in-state tuition rate.
_____ IS NOT eligible for the in-state tuition rate.
_____ I am unable to make a determination at this time. The following additional information has been requested from the applicant:
Authorized College Personnel Signature Date
Signature of Applicant Date
I certify that all above information is true.
Signature of Parent Date
If applicant is under 18 years of age.
_____ I HAVE BEEN A MASSACHUSETTS RESIDENT FOR SIX CONTINUOUS MONTHS AND INTEND TO REMAIN HERE.
As proof of my intent to remain in Massachusetts, I possess at least two of the following documents, which I shall present to the institution upon request. These documents*
are dated within one year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution reserves the right
to make any additional inquiries regarding the applicant’s status and to require submission of any additional documentation it deems necessary. Please check-o those
documents you possess as proof of your intent to remain in Massachusetts.
VALID DRIVER’S LICENSE UTILITY BILLS* EMPLOYMENT PAY STUB*
VALID CAR REGISTRATION VOTER REGISTRATION* STATE/FEDERAL TAX RETURNS*
MASS. HIGH SCHOOL DIPLOMA SIGNED LEASE OR RENT RECEIPT* MILITARY HOME OF RECORD*
RECORD OF PARENTS’ RESIDENCY FOR UNEMANCIPATED PERSON* OTHER
_____ I AM AN ELIGIBLE PARTICIPANT IN THE NEW ENGLAND BOARD OF HIGHER EDUCATION’S REGIONAL STUDENT PROGRAM.
_____ I AM A MEMBER OF THE ARMED FORCES (OR SPOUSE OR UNEMANCIPATED CHILD) ON ACTIVE DUTY IN MASSACHUSETTS.
10/29/18
STUDENT ID #:
LAST NAME
MIDDLE NAME
ADDRESS
SOCIAL SECURITY #: DATE OF BIRTH
MM
DD
CITY
Optional, but required if
seeking financial aid or tax credit.
STATE ZIP
ANY PREVIOUS LAST NAMES
FIRST NAME
Are you a U.S. Citizen? Yes No
If not, please complete the following.
ARE YOU A PERMANENT RESIDENT? YES NO IF YES, LIST ALIEN REGISTRATION NUMBER:
IF YOU ARE NOT A U.S. CITIZEN OR PERMANENT RESIDENT, PLEASE STATE YOUR VISA OR IMMIGRATION STATUS IN DETAIL:
Please check the in-state or reduced tuition eligibility category that applies to you:
Certification of Information
I certify that this information is true and accurate. I understand that any misrepresentation, omission or incorrect information shall be cause for disciplinary action up to
dismissal, with no right of appeal or to a tuition refund.
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Application Checklist (North Shore Community College)

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Completed 17 September 2020

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