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
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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.
Pittsfield High School
EDU
100
PHS
Foundations of Education
3
EDU
290
PHS
1
BIO
101
Full Year
General Biology - M.Smith
4
BIO
101
Full Year
4
AST
101
Online
Elementary Astronomy
3
ART
120
Online
3
BUS
101
Online
Intro to Business
3
AST
101
Online
3
ECO
101
Online
Principles of Economics I
3
BUS
101
Online
Intro to Business
3
ECO
102
Online
Principles of Economics II
3
ECO
101
Online
3
FSC
180
Online
Fire Science & The Law
3
ECO
102
Online
3
HIS
121
Online
US History I
3
FSC
180
Online
3
HIS
122
Online
US History II
3
HIS
121
Online
3
LEN
101
Online
Law Enforcement I
3
HIS
122
Online
3
MAT
109
Online
Elementary Stats - ALEKS
3
LEN
101
Online
3
OFT
281
Online
Medical Terminology
3
MAT
109
Online
3
PSY
101
Online
Intro to Psychology
3
OFT
281
Online
3
PSY
233
Online
Developmental Psychology
3
PSY
101
Online
3
SOC
101
Online
Intro to Sociology
3
PSY
233
Online
3
SOC
101
Online
3
NUA
101
SEC
Basic Nurse Assisting
6
NUA
103
SEC
Nursing Assistant Practicum
1
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
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FOR JWCC OFFICE USE ONLY Reviewed:________ Date:________ SCH: (if applicable) _____ _____
FA SP