FCPS College and Career Readiness
Dual Enrollment Application Form
Student Responsibilities: (Please INITIAL to indicate that you have read and understand each requirement.)
___ Ensure that all required forms are complete, correct and signed by student and parent/guardian.
___ Complete the college (PIHE) application for admission.
____ Complete this Dual Enrollment Application From. Open Campus Students: All information must be verified
and signed by the high school counseling office prior to submission to the college’s Office of Student Accounts.
___ Ensure that all diagnostic assessments/ placement tests and paperwork (application, current transcript)
required by PIHE are completed by the established deadlines
___ Pay tuition and fees and purchase required materials associated with the class. Students who do
not pay or make payment arrangements by semester deadlines will be removed from class rosters.
___ Read and adhere to PIHE policies, procedures and code of conduct.
___ Provide your school counselor with a final grade report upon course completion.
___ Notify PIHE and FCPS if you drop a course.
___ Monitor PIHE email account for notifications.
___ Pay full tuition rate for courses taken during the summer and developmental courses.
____ Ensure that you understand the eligibility implications associated with dual enrollment.
____ Complete and submit the appropriate paperwork each semester you choose to apply for dual enrollment.
Forms cannot be submitted for the discounted tuition rate after the last day of the semester.
My child is eligible for Free and Reduced Meals. (Students who meet the federal eligibility requirements for free
and reduced meals will have the tuition waived. Charges for open-campus fees and books are not waived.
I give my permission for the PIHE to provide grade reports to my/ my child’s high school counselor.
I certify that all information provided as part of this application is true and correct to the best of my knowledge. I give
my consent to FCPS for considering this application and sharing the information provided herein with the necessary
departments of ____________________
_for the purpose of registration in the dual enrollment program.
(Public Institution of Higher Education)
Student Signature: _________________________________________________ Date:
Parent/Guardian: __________________________________________________ Date:
Printed / Signature
□ High School Based Dual Enrollment □ Open Campus Dual Enrollment
*Completed applications for High School Based Dual Enrollment must be turned in to the counseling office.
*Completed applications for Open Campus Dual Enrollment must be presented to the college Registrar or
Office of Student Accounts.
Be sure to keep a copy for your records.
Student Name:
Frederick Community College courses offered
at an FCPS high school during the school day.
College courses taken on the campus of any
Public Institution of Higher Education (PIHE).
FCC ID Number:
