ODAY’S DATE__________________________ STATE STUDENT ID# _________________________
HOME SCHOOL or HIGH SCHOOL NAME _______________________________________EXP GR YEAR_____
LAST NAME FIRST MIDDLE
CELL PHONE HOME PHONE
Cell phone carrier: US Cellular Verizon AT & T Tracfone Other ___ Text Updates: ___Yes ___No
CITY STATE ZIP
COUNTY SOCIAL SECURTY #
GENDER* FEMALE MALE BIRTH DATE
MINOR RELEASE FORM REQUIRED FOR STUDENTS UNDER 18 YEARS OF AGE
ETHNIC GROUP* (CHOOSE ONE) NOT HISPANIC/LATINO HISPANIC/LATINO
RACE* AMERICAN INDIAN OR ALASKA NATIVE ASIAN
(CHOOSE ALL BLACK OR AFRICAN AMERICAN WHITE
THAT APPLY) NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
*OPTIONAL-THIS INFORMATION IS USED FOR REPORTING PURPOSES ONLY
ARE YOU MAINE RESIDENT? YES NO ARE YOU A U.S. CITIZEN? YES NO
NUMBER AND SECTION
The Aspirations Program provides a large discount of the cost of tuition. The cost of a 3-credit course would
normally range from $354 to $380. The Aspirations Program does not cover books and supplies.
Enrollment in this program is on a space available basis. Students and parents signing this form allow the
College to release a final grade to the high school in which the student is presently enrolled.
o determine eligibility for Concurrent Enrollment we need to know if the student is eligible for free or
reduced lunch. Please check yes or no.
Yes my student is eligible for free or reduced lunch.
No my student is not eligible for free or reduced lunc
Student’s Signature__________________________________________ Date___________________
Parent’s Signature___________________________________________ Date___________________
Guidance Director’s Signature___________________________________ Date___________________
Dean of Enrollment Management and Students____________________________Date__________________
: Washington County Community College is an equal opportunity/affirmative action institution and employer.
For more information; please call Tatiana Osmond, Affirmative Action Officer, at 207-454-1094.
RE – Form ASPIRATIONS Registration Form; Revised: May 7, 2020: mda