OFFICE OF ADMISSIONS
DUAL ENROLLMENT UPDATE
MTC ID: Semester Fall Spring Summer Year 20
Last Name First Name Middle
Street Address (include apt. #) City State Zip Code
Home Phone Number Email Address
High School Name
To Be Completed by Student
As a Midlands Technical College (MTC) Dual Enrollment student, I understand and agree:
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I am responsible for adhering to all MTC policies and procedures, which can be accessed at MIDLANDSTECH.EDU. I will be
responsible for any tuition and fees associated with courses taken on MTC campuses.
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MTC will release my educational records regarding courses to my parent/guardian and on my written request to the high school
or home school accountability group listed above.
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I certify these responses are true to the best of my knowledge. I understand any intentional falsification or failure to provide
complete information may result in disciplinary action including denial of admission or dismissal after admission.
Student Name (please print) Date
Student Signature Social Security Number
DUAL ENROLLMENT PARENT/STUDENT AGREEMENT
> 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 will be responsible for any tuition and fees associated with courses taken on MTC campuses.
>
I hereby give my permission for my son/daughter, , to take Dual Enrollment courses provided by MTC.
Parent Signature Date
midlandstech.edu
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PO Box 2408
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Columbia, SC 29202
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803.738.8324
HIGH SCHOOL USE MIDLANDS TECHNICAL COLLEGE USE
Grade Level (during enrolled term):
o Sophomore o Junior o Senior
Anticipated Graduation Year:
New or Returning Dual Enrollment Student?
o New o Returning
Student must place into any courses he/she wishes to take.
Placement Test Date:
Principal or Designee (printed):
Signature and Date:
High School Comments:
ACCUPLACER®
Date Taken:
Arithmetic:
Elementary Algebra:
College-Level Math:
Reading:
Writing:
o Legal Presence o SCLTA Waiver o Transcript
MTC Staff Initial and Date:
SD-17-3125-02-17
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