Fillable Dual/Concurrent Enrollment Application/Application for Enrollment Using Opportunity Program (Delgado Community College)

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Dual/Concurrent Enrollment Application/Application for Enrollment Using Opportunity Program (Delgado Community College)

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See back of Form for Application Instructions TTES Application (Revised June 2019)
Dual/Concurrent Enrollment Application/Application for Enrollment Using
Taylor
Opportunity Program for Students (TOPS) Tech Early Start Award Program
(TTES) and/or Supplemental Course Allocations
LOUISIANA OFFICE OF STUDENT FINANCIAL ASSISTANCE (LOSFA)
NOTE: Funding for TTES is contingent upon sufficient appropriations. Submission of this application for TTES does not guarantee funding.
This revised form MUST be used for ALL applications for 2019-2020 and thereafter.
A: STUDENT INFORMATION (Print or Type)
1. Type of Form: A. Initial Application B. Renewal Application LA Secure ID:
2. First Name: Middle Initial: Last Name: Suffix:
3. Birth Date:
4. E-mail Address: 5. Phone #: (____) ____ - ________
6. Permanent Home Address:
Street:
City: State: Zip Code:
7. I certify the above information is correct and that I will comply with the requirements of the TOPS Tech Early Start Program.
Stu
dent’s Signature: Date:
8. I hereby authorize my child’s concurrent enrollment in high school and college.
Parent or Custodian’s Signature: Date:
B: HIGH SCHOOL INITIAL CERTIFICATION (Print or Type)
9. Name of High School:
10. School’s BESE Code:
11. School Year and Semester covered by this certification: 20_____ - 20_____  1
st
Semester 2
nd
Semester (Check One)
Grade Level: 11
th
12
th
(check one)
12. Name of Course(s): ______________________________________________________________________________________
______________________________________________________________________________________
13. Award Eligibility Requirements:
11
th
or 12
th
Grade Student
Five-year Education and Career Plan completed
High School GPA of 2.0 or above on a 4.0 scale
Scored a 15 or above on the Mathematics AND English portion of the ACT Plan Assessment or a successor assessment, or
on ACT, or the equivalent concordant value on the SAT, or have achieved a silver level score on the assessments of the ACT
WorkKeys system. ______________Math Score ________________English Score
In good Standing as defined by the high school
14. My signature certifies that this student meets all the requirements listed in block 13, if applicable, and is authorized to be
concurrently enrolled in college.
Pr
incipal or Designee’s Signature: Date:
C: HIGH SCHOOL RECERTIFICATION (Print or Type)
15. Name of High School:
16. School’s BESE Code:
17. School Year and Semester covered by this certification: 20_____ - 20_____  1
st
Semester  2
nd
Semester (Check One)
18. Award Renewal Requirements:
 High School GPA of 2.0 or above on a 4.0 scale
 11
th
or 12
th
Grade Student
 In good standing as defined by the high school
18. My signature certifies that this student meets all the requirements listed in block 17, if applicable, and is authorized to be
concurrently enrolled in college.
Pr
incipal or Designee’s Signature: Date:
D: HIGH SCHOOL INITIAL CERTIFICATION SCA and Other Funding Sources (Print or Type)
19. Name of High School:
20.School’s BESE Code
21. School Year and Semester Covered by The Certification: 20 _____ - 20_____ □ 1
st
Semester □ 2
nd
Semester
Grade Level: □ 9
th
Grade □ 10
th
Grade □ 11
th
Grade □ 12
th
Grade
College Course Title
Course Meeting
Days
Course Time
23. My signature below certifies that this student meets all of the requirements and is authorized to be dually/concurrently enrolled in
college.
A.) Please Select ONE:
□ Dual Enrollment □ Concurrent Enrollment
B.) Please Select the appropriate payment plan:
□ SCA Funding
□ TOPS TECH Early Start Funding
□ Self – Pay
□ Other _____________________________
Principal’s/Designee’s Signature:______________________________________ Date: ___________________________
E: HIGH SCHOOL RECERTIFICATION SCA and Other Funding Sources (Print or Type)
19. Name of High School:
20.School’s BESE Code
21. School Year and Semester Covered by The Certification: 20 _____ - 20_____ □ 1
st
Semester □ 2
nd
Semester
Grade Level: □ 9
th
Grade □ 10
th
Grade □ 11
th
Grade □ 12
th
Grade
College Course Title
Course Meeting
Days
Course Time
23. My signature below certifies that this student meets all of the requirements and is authorized to be dually/concurrently enrolled in
college.
A.) Please Select ONE:
□ Dual Enrollment □ Concurrent Enrollment
B.) Please Select the appropriate payment plan:
□ SCA Funding
□ TOPS TECH Early Start Funding
□ Self – Pay
□ Other _____________________________
Principal’s/Designee’s Signature:______________________________________ Date: ___________________________
TTES Application (Revised July 2019)
Application Instructions
Student:
Initial Application (Follow these instructions if this is the first semester of the academic year that you apply for
enrollment to utilize TOPS Tech Early Start (TTES).
1. Check Block 1A and complete Section A (Student Information) of this application and have your parent or guardian
authorize your concurrent enrollment in high school and college by signing in Block 8.
2. Submit this application to your high school guidance counselor.
3. Your high school will complete Section B (High School Certification) and return the application to you.
4. It is your responsibility to submit this completed application to the admissions office at the college you will attend.
Since you will be required to complete the college’s admission forms, you should obtain those forms in advance
and submit them with this application.
Renewal Application
1. Check Block 1B in Section A and verify/update information in Section A (Student Information) of this application
and submit it to your high school guidance counselor.
2. Your high school will complete Section C (High School Recertification) and return the application to you.
3. It is your responsibility to submit this completed application to the admissions office at the college you are attending.
Since you will be required to complete the college’s admission forms, you should obtain those forms in advance
and submit them with this application.
High School Counselor, Advisor or Principal:
1. Advise students on the appropriateness of their career pursuits and participation in college level work.
2. Review this application thoroughly for accuracy and certify, by signature, that the student has met all of the program
requirements, if applicable, to participate or to continue in the program.
3. For an initial application, complete Part (B). For a renewal, complete Part (C). If the student fails to meet any of the
requirements listed, advise the student accordingly and do not process the application.
4. If the student meets the eligibility requirements, complete the application and return it to the student for submission
to the student’s school of choice.
5. Maintain a copy of this application for your files.
6. Ensure that Student Data Privacy Protocols have been followed consistent with ACT 837.
Public Postsecondary Institutions and Approved Training Providers:
After enrolling eligible students, the postsecondary institution or approved training provider may bill by submitting a
request for payment to LOSFA via the Award System.
The postsecondary institution or approved training provider must enter the TTES payment request for each semester to bill
for those students who were enrolled through the census day (after the 14
th
class day for semester schools).
By submitting a TTES payment request to LOSFA, the postsecondary institution is certifying:
a. The student meets the eligibility criteria for the college course in which the student is enrolled in TTES;
b. The student was enrolled through the census day;
c. The student’s high school has granted permission for the student to participate in the program;
d. The student meets the TTES renewal/continuation requirements; and
e. The student is in good standing at the high school and at the postsecondary institution (if renewal).
The TOPS Tech Early Start BILLING DEADLINES are:
Fall Semester:
Billing Begins - Begin billing after your school’s census date
October 15 - Fall billing deadline: Billings after this deadline will not be approved.
November 14 - ALL Fall billing corrections must be completed and processed
Spring Semester:
Billing Begins - Begin billing after your school’s census date
April 1 - Spring billing deadline: Billings after this deadline will not be approved.
April 30 ALL Spring billing corrections must be completed and processed
(In cases where the dates above fall on a weekend or declared holiday, the deadline will be the next working day.)
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DualConcurrent Enrollment ApplicationApplication for Enrollment Using Opportunity Program (Delgado Community College)

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Completed 26 July 2020

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