Berkshire County High School Students have the opportunity to enroll in BCC credit courses. Students may take any college course for which they meet the
pre-requisites. Please note the transferability of credit to another institution is determined by the receiving institution.
Please choose which early college program you are applying for:
 BRIDGE TO COLLEGE: Seniors Only. Tuition/fees waived for one course per year. Student responsible for books and transportation.
 CONCURRENT: High School Course approved for BCC college credit.
 DUAL ENROLLMENT: High School students enroll in college course. Student responsible for tuition, fees, books and transportation.
Please check off each section below to complete this form:
STUDENT INFORMATION
Name
LAST FIRST M
Address
NUMBER/STREET CITY STATE ZIP
Email
Social Security Number
Date of Birth
Phone
High School
Gender    Female    Male
Are you Hispanic/Latino (optional)?    Yes    No
Please select (optional): 
American Indian/Alaskan Native  Asian  Black/African American  Native Hawaiian/Pacic Islander  White
ACCUPLACER TEST
Have you completed the Accuplacer test at your high school or BCC?: Yes    No Date Completed
Do you have a high school GPA of 2.7 or higher? If so, you are excused from Accuplacer Reading/Writing.
Otherwise, contact the BCC Testing Center at 413-236-1655 to schedule an appointment - and inform the staff you are an early college applicant.
COURSES
List the BCC course(s) below that you wish to take, including day, time and location (visit coursecatalog.berkshirecc.edu to see current course listings).
Contact Shelly Armstrong, academic advisor, at (413) 236-1639 to schedule a registration appointment. Bring this completed form with you to register.
1
st
Choice BCC Course ID/Section
Name, Day/Time
2
nd
Choice BCC Course ID/Section
Name, Day/Time
REQUIRED SIGNATURES
A parent/guardian signature is required if the student applicant is under 18 years of age. Your signature indicates permission for the student to participate in
the program, and for BCC to release enrollment information (including ofcial transcripts) to the high school. By signing below, you agree to abide by the
rules and regulations of BCC and accept the courses indicated.
I certify that the information on this application is complete and accurate to the best of my knowledge.
Student Signature  Date
Parent/Guardian Signature  Date
GUIDANCE COUNSELOR
Please complete the following. Your responses will not affect the student’s enrollment. Your signature certies that the named student is currently enrolled, is
a student in good standing, and/or you approve of their course selection.
SASID#
Graduation Year
This student currently maintains a GPA of 2.7 or higher. Yes    No: If no, please provide their GPA:
This course will be accepted for high school credit. Yes    No
Signature
 Date
MONTH/DAY/YEAR
Early College Application
(Please type or print)
Name
LAST FIRST M
Address
NUMBER/STREET CITY STATE ZIP
Phone
High School
Email
Social Security Number
Date of Birth
A
re you a U.S. Citizen?  Yes 
No — If not, please complete the following:
Are you a Permanent Resident?  Yes. Alien registration number No 
If you are not a U.S. Citizen or Permanent Resident, please state your Visa or immigration status:
PLEASE CHECK THE IN-STATE OR REDUCED TUITION ELIGIBILITY CATEGORY THAT APPLIES TO YOU:
Are you under 18 years old? 
Yes. Please provide parent/guardian residency documentation.  No
I have been a Massachusetts resident for six (6) continuous months and intend to remain here. As proof of my intent to remain in Massachusetts,
I POSSESS AT LEAST 2 OF THE FOLLOWING DOCUMENTS, which I shall present to the institution upon request. These documents* are dated
within one (1) year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution
reserves the right to make any additional inquiries regarding the applicant’s status and to require submission of any additional documentation it deems
necessary. Please check-off those documents you possess as proof of your intent to remain in Massachusetts.
Valid drivers license
Utility bills*
Employment pay stub*
Valid car registration
Voter registration*
State/federal tax returns*
MA high school diploma
Signed lease or rent receipt*
Military home of record*
Record of parents’ residency for
un-emancipated person*
Other
I am an eligible (ME/NH/VT/RI/CT) participant in the New England Board of Higher Education’s Regional Student Program.
I am a permanent legal resident of the state of New York.
I am a member of the armed forces (or spouse or un-emancipated child) on active duty in Massachusetts.
CERTIFICATION OF INFORMATION
I certify that this information is true and accurate. I understand that any misrepresentation, omission or incorrect information shall be cause for
disciplinary action up to dismissal, with no right of appeal or to a tuition refund.
Student Signature  Date
Parent/Guardian Signature  Date
(REQUIRED IF APPLICANT IS UNDER 18 YEARS OLD.)
FOR OFFICIAL USE ONLY — DO NOT WRITE BELOW THIS LINE
I have reviewed the above information in order to determine this individual’s eligibility to receive the in-state tuition rate. Based on my review I have
determined that this individual:
IS eligible for the in-state tuition rate.
IS NOT eligible for the in-state tuition rate.
I am unable to make a determination at this time. The following additional information has been requested from the applicant:
Authorized Signature
 Date
Berkshire Community College is an afrmative action/equal opportunity institution and does not discriminate on basis of race, creed, religion, color, gender, gender identity, sexual orientation, age, disability, genetic information,
maternity leave, military service, and national origin in its education programs or employment, pursuant to Massachusetts General Laws: Chapter 151B and 151C; Title VI, Civil Rights Act of 1964; Title IX; Education Amendments
of 1972; Section 504; Rehabilitation Act of 1973; Americans with Disabilities Act; and regulations promulgated thereunder, 34 C.F.R. Part 100 (Title VI), Part 106 (Title IX) and Part 104 (Section 504). All inquiries concerning ap-
plication of the above should be directed to Melissa Loiodice, Director of Human Resources and Afrmative Action Ofcer; and Coordinator of Title IX and Section 504, at 413-236-1022,SBA Annex, Room A-20.
MONTH/DAY/YEAR
Massachusetts Community Colleges
In-State Tuition Eligibility Form
(Please type or print)
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