PERT: Reading 106 Writing 103 Math 114 Intermediate Algebra or Math 123 College Algebra
OCPS ONLY: Minimum score of 96
SAT:
Reading 24 Writing 25 Math 24 Intermediate Algebra or Math 26.5 College Algebra
ACT: Reading 19 English 17 Math 19 Intermediate Algebra or Math 21 College Algebra
U.S. Citizen: q Yes q No (If no, please complete non-U.S. citizenship below)
Country of birth __________________________________________
Non-U.S. Citizenship (Please check all that apply):
Country of birth __________________________________________
Country of citizenship _____________________________________
q Permanent Resident q Refugee/Asylee
q International Student q Permanent Residency Pending
Do you consent to DE sending you text message alerts?
q Yes q No
Are you a previous applicant? q Yes q No
If previously applied, VID# will be the same.
GENERAL INFORMATION (PLEASE TYPE)
1
COUNSELOR INFORMATION
(TO BE COMPLETED BY GUIDANCE COUNSELOR OR HOMESCHOOL PARENT)
3
PARENT/GUARDIAN AND STUDENT SIGNATURES
2
Dual Enrollment Admission Application
Summer/Fall 2018
Please help us comply with federal regulations by indicating your
ethnic group (optional): q I do not wish to indicate an ethnic group.
What is your ethnicity? q African American or Black
q Asian or Pacific Islander q Caucasian q Hispanic
q South American Indian q Other ______________________
Name of School Anticipated Graduation Date (Month/Day/Year)
Name as it appears on Social Security card, driver’s license or passport.
All applications must be submitted to your school’s DE representative. Homeschool students must check DE website at valenciacollege.edu/dual
for submission details and additional documentation requirements. To expedite your application, please type.
(APPLICATIONS WILL NOT BE ACCEPTED FROM STUDENTS/PARENTS AT ANY VALENCIA COLLEGE CAMPUS)
Student’s Personal Email Address. DO NOT use OCPS or SDOC email address. Student’s Cell Phone Number
State Zip Code Telephone Number
City CountyMailing Address Apt/Unit
Last Name First Name Middle Initial
Social Security Number
MONTH DAY YEAR
Birth Date
Gender (optional)
q Female q Male
I authorize my parent/legal guardian to obtain information about my academic records.
(Permission ends upon student’s graduation from high school.): q Yes q No
Name of parent/legal guardian to whom my information may be released (REQUIRED): (1)____________________________________________
Student’s Signature: ________________________________________ (2)____________________________________________
PARENT(S)/LEGAL GUARDIAN(S)
I have read and agree to the terms of this application. I hereby grant approval for my son/daughter/legal ward to enroll in Valencia courses as a
dual enrollment student, while still enrolled in grades 6 – 12. I accept full responsibility for any and all personal matters, such as transportation,
insurance coverage, financial arrangements, etc. I understand that SAT/ACT scores are not valid until received by College Board or ACT.org and
processed by Valencia College, and that this process takes up to five weeks. It is the applicant’s responsibility to request test scores.
Parent/Legal Guardian’s Printed Name: ____________________________________________________________
Parent/Legal Guardian’s Signature: ________________________________________________________________ Date: ________________
My signature below certifies that the student meets the required CGPA to participate in dual enrollment (6-11th grades: minimum 3.0 unweighted
GPA; 12th grade: minimum 3.0 weighted GPA) and has been informed of his/her high school graduation requirements which must also be satisfied.
Student’s High School CGPA: _______ Student’s School ID#: ____________ Counselor’s Printed Name: _________________________________
Counselor’s Signature: ______________________________________________________________________ Date: ______________________
PLEASE INDICATE STUDENT’S COLLEGE-READY SCORES:
PERT Reading ______ Writing ______ Math _______
These scores will be retrieved from the PERT repository. If your school offers the PERT after application submission, the student must update
their scores through the “Submit High School PERT Scores” link at valenciacollege.edu/dualenrollment
OCPS ONLY: Please indicate students score on FSA/EOC. ______ Level 3+ on Grade 10 FSA ELA ______ Level 3+ on Algebra I EOC
© 2018 Valencia College | 17EMC018
I AM APPLYING FOR: q Summer 2018 q Fall 2018
Summer 2018 course options are limited. Students who do not meet summer 2018 deadlines will automatically be considered for fall 2018.
SUMMER DEADLINES Application and test score: April 6 FALL DEADLINES Application: April 6 | Test score: April 20
