CL 10/17
Bucks County Community College and Temple University
Former Temple University students are not eligible for this program.
Name: Date of Birth
Last four digits of SSN: BCCC ID #
City State Zip
Primary phone: Email address:
Do you currently have 30 or fewer credits from BCCC and any other institution? (Students must have thirty or fewer
completed credits from all institutions attended in order to be eligible for Dual Admissions.)
Yes No
Have you previously attended another college? Yes No
If yes, what institution(s)
Note: Failure to disclose credits earned from other institutions may negate program eligibility.
Major at BCCC:
Semester you began at BCCC (m/y)
Expected Date of Graduation from BCCC:
Intended major after transfer:
(Dual Admissions does not guarantee admission into specific majors as some majors have additional admission
Date you expect to enroll at Temple:
I wish to enroll in the Dual Admissions Program with Temple University. This program allows me to be admitted into
Temple University after meeting certain conditions, and completing my associate degree from BCCC. I understand
that I must complete Temple’s online application and indicate that I am a Dual Admissions student; the semester
before I am ready to transfer by the required deadline. I understand that Temple University will waive my application
fee. I understand that a minimum 2.3 cumulative GPA is required for Dual Admission into Temple (and a 3.3 or
higher GPA for scholarship). I authorize BCCC and Temple to exchange information, as needed, including the
information on this form, and academic transcript data, in order to facilitate my transfer under this agreement. I
understand that it is my responsibility to apply for graduation at BCCC and that in order to maintain my Dual
Admissions status, I must enroll at Temple within one year of my graduation and cannot attend another institution of
higher learning before I enroll at Temple.
Student’s signature: Date:
Return to the BCCC Office of Enrollment Services, Linksz Pavilion, First Floor
BCCC: Start Term _________ Term Reg _______ Completed Credits _______________
Prior C/U _____________________________________________ Tran _______________
Prior C/U _____________________________________________ Tran _______________
Eligible _____________ BCCC Signature ___________ Date _______________