Smart Start
application &
courSe regiStration
Please Note–Course availability is limited–Students are responsible for payment of total bill one week before the start of classes.
Estimated Cost $166 per credit hour; online $196 per credit hour (pending JWCC Board Approval June 2020)
High school students awarded 25% reduction on regular tuition and universal fees (Estimated cost: structured – $125.25
per credit hour; online – $155.25 per credit hour)
Books for classes can be found at www.jwcc.edu/bookstore/ or call 217.641.4230
Business Oce payment options: Payment plan open June 2020 (fall courses) and November 2020 (spring courses). To pay by credit
or debit, call 217.641.4207 (www.jwcc.edu/business-oce/).
High School Name___________________________/Grad Date__________
(Please PRINT and ll out COMPLETELY - Return form to JWCC Enrollment Services – smartstart@jwcc.edu)
Name: _________________________________________________________________________________
Last First Middle Initial
Address: _______________________________________________________________________________
Preferred Email: ______________________________________________ Phone: ____________________
SSN: |__|__|__| - |__|__| - |__|__|__|__| Date of Birth: ______________ Gender: Male Female
(Social Security Number is required for tax reporting purposes for educational expenses)
Please check online at jwcc.edu to see a full listing of course offerings.
OFFICE OF ADMISSIONS
1301 South 48th St | Quincy, IL 62305
217.641.4339 | Fax: 217.221.0778
smartstart@jwcc.edu
Page 1 of 2
Fall 2020 (August Start)
Check
Course
Selection
Course
Prex
Course
No.
Attending
Center
Course
Cr.
Hrs.
Spring 2021 (January Start)
Check
Course
Selection
Course
Prex
Course
No.
Attending
Center
Course
Cr.
Hrs.
Quincy Senior High School
EDU
100
QHS
Foundations of Education - Stalder
3
EDU
204
QHS
3
EDU
290
QHS
Clinical Experience in EDU - Stalder
1
CMN
101
JWCC/Online
3
CMN
101
JWCC/Online
Intro to Speech I
3
EDU
201
Online
3
EDU
201
Online
Education Psychology - 8wks
3
ENG
101
JWCC/Online
3
ENG
101
JWCC/Online
Rhetoric & Composition I
3
ENG
102
JWCC/Online
3
ENG
102
JWCC/Online
Rhetoric & Composition II
3
MAT
109
JWCC/Online
Elementary Stats
3
MAT
109
JWCC/Online
Elementary Stats
3
MAT
113
JWCC/Online
3
MAT
113
JWCC/Online
College Algebra
3
PSY
101
JWCC/Online
3
PSY
101
JWCC/Online
Intro to Psychology
3
SOC
101
JWCC/Online
3
SOC
101
JWCC/Online
Intro to Sociology
3
Have you ever attended John Wood Community College (including dual credit courses)? Yes No
Please identify your primary racial/ethnic group. (select only one)
Asian American Indian or Alaskan Native Black or African American Hispanic or Latino
White Native Hawaiian or Pacic Islander Choose not to respond/unknown
Are you Hispanic or Latino? (Or are you of Spanish origin?)
Yes, I am Hispanic or Latino No, I am not Hispanic or Latino
Are you from one or more of the following racial groups? (Select all that apply)
Asian American Indian or Alaskan Native Black or African American
White Native Hawaiian or Pacic Islander Choose not to respond/unknown
Are you in the United States on a Visa?
No, I am a citizen of the United States
No, I am not a citizen of the United States, but am a legal resident alien or refugee.
Resident #________________
Yes, I am in the United States on a Visa Home Country of Origin:______________ Visa Type:__________
FERPA, the Family Educational Rights and Privacy Act of 1974, protects the privacy of student educational
records—To authorize, the student understands the information presented on this form and gives permission to the high
school and John Wood Community College to share, collaboratively, information related to his/her dual enrollment pro-
gram participation, as well as with his/her parent/guardian while enrolled in the concurrent enrollment course(s).
Granted access to parent/guardian listed below:
________________________________________________ ___________________________________________
Student’s Signature Date
________________________________________________ ___________________________________________
Parent/Guardian Signature Date Parent/Guardian Signature (optional) Date
________________________________________________ ___________________________________________
Parent/Guardian Name (print) Date Parent/Guardian Name (print) (optional) Date
________________________________________________ ___________________________________________
Parent/Guardian Email Address Parent/Guardian Phone #
FOR HIGH SCHOOL COUNSELOR ONLY
High school Transcript attached Geometry_______ Alg II________ UNW GPA________
(If needed)
SAT Critical Reading ________ Math_________
ACT Critical Reading ________ Math_________
ACCUPLACER ___________________________
Counselor Comments
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
____________________________________________ _______________________________________
Counselor’s Signature Date
Page 2 of 2
FOR JWCC OFFICE USE ONLY Reviewed:________ Date:________ SCH: (if applicable) _____ _____
FA SP
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome