High School Dual Enrollment – Signature Sheet
Please print and use your full LEGAL name:
Last Name:_________________
_____________________ First Name:_______________________________________ Middle_________
High School:_ Date
of Bir
th: _
Please circle
one
Grade Le
vel: 9, 10, 11, or 12 ____________________________________ ____________________________________
Area of
Study/Interest: _______________________________________________
Step 1. Apply Online New and returning dual enrollment students
Step 2. Read and Sign
• I certify that all information I have provided in this application is correct and that I will comply with all BPCC Dual Enrollment requirements. I understand that I
am enrolling as a Visiting/Guest Student at BPCC. Upon graduation from high school, if I desire to enroll at BPCC, I will apply for admission as a regular student
and meet BPCC's admission requirements.
• I understand that, if necessary, I must file separately with BPCC’s Office of Disabilities for special accommodations, which is a separate and distinct process from
that which is performed at the high school.
• I understand that the college courses and high school and college grades earned in those courses in which I enroll through the BPCC Dual Enrollment program
will be on my permanent high school and college academic records.
• I understand that the grades I earn on college courses in which I enroll through the BPCC Dual Enrollment program will be used by other programs, including ALL
FINANCIAL AID PROGRAMS, to determine my continuing eligibility for those programs.
• I do hereby authorize the Board of Regents and the Office of Student Financial Aid access to my high school and college academic records.
• I acknowledge that I am enrolling in the course listed above and also understand that it is my responsibility to OFFICIALLY WITHDRAW or DROP a class that I
decide not to complete by BPCC's published deadline. If I withdraw I may not be eligible for Dual Enrollment participation next semester. In addition, I
understand that withdrawing or not completing my courses(s), may affect any future financial aid (Pell Grants, TOPS, TOPS Tech, etc.) that I am eligible to
receive after graduation from high school.
• I agree to the exchange of academic, financial, and disciplinary information among the student's high school, BPCC, LaDOE, LOFSA and parent/legal guardian.
• By signing this form, I hereby acknowledge that I understand that Bossier Parish Community College students become obligated to pay all tuition, fee, and
associated charges at the time of registration.
• Bossier Parish Community College expects students to meet their financial obligations in a timely manner and to understand that failure to do so will result in
further action to collect the balance due. This may include the transfer of the balance due to the State of Louisiana Office of the Attorney General for collection.
An individual with a transferred account is responsible for all collection charges including, but not limited to, attorney and court costs.
• I further acknowledge that it is a student’s responsibility to understand all College policies and procedures related to managing their registration and student
account. Those include the College’s Add/Drop, Withdrawal, and Refund Policies.
Principal/Designee Signature
Step 3. Return this form to your high school Dual Enrollment Official
Step 4. To be Completed by High School Official High School Site Code:____________
High school official must indicate the college course in which the student has permission to enroll and the respective high school course in which the student will receive
high school credit. Signing further certifies that the student is in good standing as defined by the high school and has completed a Five-Year Education Plan. All tuition
and fees for the courses enrolled will be billed according to the Memorandum of Understanding between Bossier Parish Community College and the Parish School
Board Office or school. If no MOU exists, the student is responsible for payment.
High School (LDE)
Course Number
Submit the following documents with signature sheet:
New Student
High School Transcript
Selective Service Verification
(Only if student is male & 18)
Immuniza
tion Waiver
ACT, SAT, PLAN, or PSAT Scores
Homeschool only: Approved Louisiana Department of Education Home Study Program Application (must be submitted each Fall)
Returning Student
High School Transcript
Selective Service Verification
(Only if student is male & 18)
For BPCC
use only
LOLA# ________
_______________________________
______SAADCRV ______SOATEST ___
___SGASADD ______ SOAHOLD ______GOATPAC
7. Select: Apply Now!
8. Are you enrolled in high school: Yes
9. Will you still be in high school when starting classes: Yes
10. Major or Campus: Campus
11. Which campus are you interested in attending: Main Campus
12. Select a Major: 4025 *Major Description Not Found*
13. Complete all required information
14. Certification statement – Select Check box
1. Please access your Social Security Number before beginning
the online application.
2. https://www.bpcc.edu/index.php/dualenrollment-applyonline/
3. Select: Apply Now
4. Select: Apply Online (New User)
5. Click “Don’t Have An Account Yet? Sign up!” (New students)
Click “I Already Have An Account!” (Returning students)
6. Select Term: Fall 2020
