Fillable Early Enrollment High School ( Provisional) Application (New River Community and Technical College)

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Early Enrollment High School ( Provisional) Application (New River Community and Technical College)

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NEW RIVER COMMUNITY AND
TECHNICAL COLLEGE EARLY
ENROLLMENT
Application, Registration and Approval form
INSTRUCTIONS: Students taking only in seat courses through their high school or
through their high school online environment as dual credit should wait to apply for
admission once instructed through their high school as New River CTC works closely
with administration and instructors in this process. However, if you are planning on
taking both dual credit courses through the high school and courses for early
enrollment through New River CTC (in seat or online), you may apply and register
through the Office of Admissions with New River CTC and add your high school
courses later when instructed by your school. You will only need to complete the
application process once for each semester, even when taking both dual and early
enrollment classes.
9.11.2020- Enrollment Services & Registrar’s Office
You will be admitted as a part-time high school student. You will be required to provide proof of meeting course entrance
prerequisites if applicable for registration purposes. Prerequisites may be found in the college catalog under course
descriptions, https://www.newriver.edu/college-catalog/
. You may submit your unofficial college transcripts, ATC or SAT
score(s) meeting the minimum score requirements, or take our Accuplacer placement test through the Student Success
Center. Proof must be submitted before registering.
PLEASE PRINT ALL INFORMATION CLEARLY IN ORDER TO PROCESS
Name of high school _____________________________________________ County _________________________
Legal Name
________________________________________________________________________________________________
First name Full Middle name, not initial Last name
Mailing Address (where you receive mail), Street or P.O. Box: _____________________________________________
C
ity _______________________ State: _______ Zip code: _____________ County __________________________
_
Telephone number to reach you with area code _____________________ Cell Home Work
Legal Sex Male Female Date of Birth __________________________
Month Day Year
Social Security Number ____________________________________ if unsure, please verify by your SS card.
_
Are you a U.S. Citizen? Yes No Marital Status Married Widow Divorced Separated
Please select one or more of the following that best describes you:
American Indian or Alaska Native Asian Black or African American Hispanic or Latino
Native Hawaiian or Other Pacific Islander White
What is your ethnicity? Hispanic or Latino Not Hispanic or Latino
Your personal email address________________________________________________________________________
You will be assigned a college email address. For instructions, visit https://www.newriver.edu/student-video-resources/
Emergency Contact: Name (First and Last) ____________________________________________________________
______
Relationship: _______________________________Telephone number with area code ___________________________
Planned entry year 20____ and semester in which you are applying for:
Fall (August – December) Fall Rolling Start (after regular semester starts, 10 week courses)
Winter Session (December – January) Spring (January - May) Spring Rolling Start (after regular semester starts,
10 w
eek courses)
Summer ten-
week (end of May - July) Summer 1
st
five-week Summer 2
nd
five-week
Note: Rolling Start, Winter session and 5-week courses have limited course offerings and are accelerated. Academic
calendars may be viewed at https://www.newriver.edu/academic-calendar/
. Course schedules may be viewed at
https://www.newriver.edu/course-schedules/. Login in as guest.
Are you a U.S. Citizen? Yes No Are you a WV resident? Yes No If yes, How long? _________________
Where will your New River CTC classes be taken?
At my high school On campus or online New River CTC Both- high school and New River CTC
Choose a location, closest campus if online or where you will attend and/or your records will be housed:
Advanced Technology Center (Ghent) Greenbrier Valley Campus (Lewisburg)
Mercer County Campus (Princeton) Nicholas County Campus (Summersville) Raleigh County Campus (Beaver)
Expected high school graduation date ___________________
Month/Year
If returning online, the student may type name to stand as signature instead of signing.
Student Signature: x _____________________________________________________ Date: ____________________
If any part of the application or registration is missing information, it will not be processed. Please review before submission. Thank you.
Page 1 of 3
EARLY ENROLLMENT APPLICATION FOR ADMISSION
(For current high school students enrolling in college courses)
Staff Use- New River CTC 9 digit Student ID # _____________________________________
9.11.2020- Enrollment Services & Registrar’s Office
Course schedule may be viewed online, https://www.newriver.edu/course-schedules/
Student Name ______________________________________________________ Date of Birth ______________________
Month Day Year
Name of High School _____________________________________________________
COURSE REGISTRATION INFORMATION Credit Days (M,T,W,R,F) and times Room #
College CRN # Subject Course # Course Title Hours or Online. R=Thursday (on campus) or
Mode
EXAMPLE:
12345
COSC
101
Microsoft Office Applications
3
WEB
TOTAL HOURS: _____
PARENT OR GUARDIAN PERMISSION AND STUDENT ACCEPTANCE
We understand and acknowledge that:
• He/she will be considered a part-time college student once admission is complete and he/she is registered.
• This form is written consent to apply for admission and to register for a course and/or courses.
• He/she will have an official college transcript with a permanent grade recorded for each class registered for.
• If he/she decides not to finish a course, he/she will need to complete a form to drop or withdraw. Failure to
drop or withdraw from a course will result in an F as a grade or an FIW (failure to attend). Add/Drop forms may be
used until the deadline for schedule adjustment. The Request for Withdrawal form must be used after this deadline or
when a student is completely withdrawing from the college for the semester.
The Academic Calendar along with forms such as complete withdrawal and transcript requests may be found
at https://www.newriver.edu/registrars-office/
. Forms should be submitted to the Registrar’s Office.
Registration, drop or withdrawal questions? Contact the Registrar’s Office by e-mail, registrar@newriver.edu
or by calling 304-929-5032.
We have read and understand the student responsibilities and we understand he/she must drop a course or
withdraw from all courses if he/she no longer wishes to participate. Additional information may be found in the
college catalog, https://www.newriver.edu/college-catalog/
or by contacting the Registrar’s Office.
________________________________________________________________________________ If guardian, initial here _______
PRINTED NAME of Parent or Legal Guardian:
If returning online, parent, guardian and/or student may type name to stand as signature instead of signing.
x________________________________________________________________________ ______________________
SIGNATURE of Parent or Legal Guardian Month Day Year
x________________________________________________________________________ ______________________
STUDENT SIGNATURE
Month Day Year
Visit www.newriver.edu
for more information.
Page 2 of 3
RECOMMENDATION FORM FOR HIGH SCHOOL PROVISIONAL STATUS
Student and Parent Consent for Registration
9.11.2020- Enrollment Services & Registrar’s Office
This is to certify that _______________________________________________________________________________
PRINTED NAME of student (First, Full Middle Name, Last)
Date of Birth: ___________________ Name of High School: ____________________________
Month Day Year
Please confirm student meets criteria for Admission/Registration:
Student is a junior or senior in high school Student has a GPA of 2.5 or better
Student is recommended to participate in college coursework at New River Community and Technical
College and has permission to enroll (register) during the following semester.
Planned entry year 20 ____ and semester in which approval is given. You may check multiple boxes within the
same semester only, such as Fall and Fall Rolling Start for example. Consent is valid for one semester.
Fall (August – December) Fall Rolling Start (after regular semester starts, 10 week courses)
Winter Session (December – January) Spring (January - May) Spring Rolling Start (after regular
semester starts, 10 week courses)
Summer ten-week (end of May - July) Summer 1
st
five-week Summer 2
nd
five-week
Permission to register (choose one):
OR
Place a “X” here ______ if the student The student may enroll in the following New River
may enroll in any coursework chosen at River CTC course(s) ONLY as listed below (if
New River CTC. eligible) during the semester indicated above.
List courses below.
NOTE: A student must meet pre-requisites or
meet minimum placement scores in order to
register in certain courses.
PRINTED NAME of Principal or approved designee_____________________________________________________
Note: Approved designee must be on file with the Director of Enrollment Services. A form is available through your
Campus Director or by emailing tevans@newriver.edu
If returning online, the Principal or approved designee on file may type name to stand as signature.
X________________________________________________________________________ Date: _____________
Principal’s Signature or approved designee (form must be on file for approved designee).
Page 3 of 3
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
PRINCIPAL RECOMMENDATION PROVISIONAL FORM
Consent for Registration
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Early Enrollment High School ( Provisional) Application (New River Community and Technical College)

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Completed 4 February 2021

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