Dual Credit/Early Admission Application
6200 College Avenue
Snyder, TX 79549
Updated: 1/18/2021
Instructions: Please complete this form in blue or black ink. Be sure to answer each question. All documents submitted to the
college become part of your official file and cannot be returned. I acknowledge that academic or disciplinary concerns may
be discussed by the appropriate official and my parents or legal guardian.
Social Security Number: _________ - ________ - _________
Name: _____________________________________________________ Date of Birth: _____ / _____ / _____ Gender: _____
(Please Print: First, Middle, Last)
Mailing Address: ________________________________________ City: _________________ State: _____ Zip: ___________
County: ______________________ Home Phone: __________________________ Cell Phone: _________________________
High School: _________________________________________ Grade Level: ________ Entry Term: ____________________
Ethnic Data (These items are used to satisfy State/Federal reporting requirements and in no way affect the admission decision).
Asian □ Black/African American □ Latin/Hispanic □ White
□ American Indian/Alaskan Native Hawaiian/Pacific Islander □ International/Non Resident
1. If either parent has attended college, what is their highest level of education?
___1 Year ___2 Years ___3 Years ___Completed Bachelor's or Above Degree
2. Please check all that apply: (This is used to satisfy State/Federal reporting requirements).
Academic Disadvantage Economic Disadvantage Disable Primary Language is English
Single Parent and/or Single Pregnant Woman Homeless in Foster Care Active Military Parent(s)
3. Anticipated high school graduation date: ____________ (month) _____________ (year)
4. Have you taken college classes from a previous institution? Yes No If yes, please list previous college or university.
5. What major field of study are you planning to pursue? ____________________________________________________________
Degree: Associate of Arts Associate of Applied Science Certificate Undecided
Parent/Student consent for the release of information and participation in the Dual Credit program for the duration of the
student’s high school career.
I, ________________________________________ and ___________________________________, understand;
(Print: Parent/Legal Guardian Name) (Print: Student Name)
The law requires you to provide your correct
U.S. Social Security Number so WTC can
furnish certain tax return information to the IRS and to you.
Updated: 1/18/2021
Students are responsible for knowing and adhering to the drop date deadlines for withdrawal on the Western Texas College
academic calendar.
Submitting this consent form does not guarantee eligibility or enrollment into the program or selected courses. Eligibility and
enrollment into the Dual Credit program and courses is dependent on a complete application packet submitted by the deadline
and qualifying test scores for each course selected, as determined by Western Texas College and the high school.
Grades earned in dual credit become part of the student’s permanent academic record and will be reflected on the college
Students may be enrolled in dual credit courses approved by the high school.
Students must attend their Dual Credit class regularly and turn in all required assignments. Students may be withdrawn for lack
of attendance and/or lack of progress. This attendance policy pertains to all students enrolled in any section of a dual credit
course on any campus with the exception of homebound students. If for any reason the student is not attending the Dual Credit
class at the high school regularly, he/she will be withdrawn from the class (includes students sent to alternative school and
homebound students). Students underperforming are encouraged to drop the course before the drop date.
Students who choose to take regular college courses outside the dual credit program requirements will be admitted as Early
Enrollment and responsible to meet all admission requirements for the program as well as pay full tuition and fees based off
residency status for all courses.
Pursuant to student rights under the Family Educational Rights and Privacy Act (FERPA), the student gives permission for WTC to
disclose (verbally or in writing) information concerning education and financial records to high school administrators while
enrolled as a dual credit student. (See https://www.wtc.edu/ferpainformation.html for more information.)
Pursuant to student rights under FERPA, the student gives WTC permission to disclose (verbally or in writing) information
concerning educational and financial records to the parent(s)/guardian(s) listed on this dual credit application while enrolled as
a dual credit student. A student that does not wish to share this information must submit a request (in writing) along with this
This form is valid for the duration of the student’s participation in the Dual Credit Program.
Student Acknowledgement
I, the student above, read and agree to all the standards and policies outlined above and in the Dual Credit Handbook and
WTC Student Handbook.
Student Signature ____________________________________________ Date: _______________________
Parent/Guardian Acknowledgement
I, as a parent/guardian for the student mentioned above, state that I read and agree to all of the standards and policies
outlined above and in the Dual Credit Handbook and WTC Student Handbook. This may be found at
https://www.wtc.edu/. I give permission for my child to participate in the Dual Credit/Early Admission Program at
Western Texas College.
Parent or Legal Guardian Signature: __________________________________________ Date: ______________________
High School Designee
High School Principal/ Counselor Signature: ____________________________________ Date: ______________________
State law gives you the right to request, receive, and correct information about yourself collected on this form. Western Texas
College does not discriminate on the basis of race, religion, color, national origin, sex, genetic identity, sexual orientation,
veteran status, age, or disability with respect to access, employment programs or services.
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