(To be completed by the Guidance Counselor or an Authorized Homeschool Representative)
SCHOOL DEPARTMENT AUTHORIZATION FORM
STUDENT REGISTRATION
First Name: Last Name: 900#
Current Grade: Freshman Sophomore Junior Senior Year of Graduation:
SASID
10 Digit #: High School G.P.A.:
This student is enrolled in the Career Vocational Technical Education Program: Yes No
Program Name:
This student is enrolled in the BRISTOL Educational Talent Search Program or Upward Bound Program
This student is a first time Dual Enrollment participant: Yes No
This student will utilize one of our allotted slots: Yes No If yes: Low Income Non-Low Income
Guidance Counselor or A.H.R.
(Print) Signature Date
A signature attests to the accuracy of the information provided, including course(s) selection.
Phone: Email: Allocation Slots: of
High School Transcripts must be attached.
Courses to be Registered for : All In order of preference Term: Fall Spring Summer
Alternate Course
CRN Course No. Sect. Title Credits Day Time
** Students should designate an alternate course because their first choice may be full or the course may be cancelled.
Please Do Not Write Below This Line For Office Use Only
Dual Enrollment CDEP CVTE Self-Pay Bristol Employee Pell Experiment Contract Course | Bristol Waiver: Non-LI LI
HS GPA: BRISTOL GPA:
If the student does not meet the GPA, a request to waive the GPA requirement has been submitted: Yes:____ No____
Signature (BCC Administrator): ____________________________________________ Date: _________________________
V.10/2019 Page | 3
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