Fillable The Bristol Dual Enrollment Application Here (Bristol Community College)

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The Bristol Dual Enrollment Application Here (Bristol Community College)

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The The Bristol Dual Enrollment Application Here (Bristol Community College) form is 2 pages long and contains:

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  • 36 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bristol Community College

BROWSE BRISTOL COMMUNITY COLLEGE FORMS

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DUAL ENROLLMENT PROGRAM
777 Elsbree St, Fall River, MA 02720
BRISTOL
Phone: 774.357.3519
Please submit application to email: dual.enrollment@bristolcc.edu
COMMUNITY COLLEGE
Attleboro | Fall River | New Bedford | Taunton | Online
First Name:
Last Name:
Intended semester of study:
Fall 20
Spring 20
Summer 20
D.O.B.
BCC Student ID # 900-
Mailing Address:
Biographical Information
Male Female Non-Binary
Pronouns: She/Hers He/His Them/They
How do you describe yourself:
Hispanic, Latino (X) or Mexican
Caucasian Portuguese
African American Cape Verdean
Native America Asian
Pacific Islander Multi-Racial
City:
Zip Code:
Home Phone:
Cell Phone:
Email:
Required for registration confirmation.
Did your mother earn a 4 year college
degree? Yes No Unsure
Did your father earn a 4 year college
degree? Yes No Unsure
After H.S., do you plan on attending
BCC? Yes No Unsure
High School Name:
Year of Graduation:
SAT/ACT or Accuplacer Testing Scores*:
Reading Writing Mathematics
* Submit a print out of SAT/ACT scores with application before taking the Accuplacer
STUDENT CERTIFICATION
As a Dual Enrollment high school student, I understand that it is my responsibility:
to pay for all textbooks and any special program fees associated with completing the course(s)
to have completed all prerequisites listed in the BRISTOL catalog
to arrange my own transportation to the site where the course(s) will be offered
to provide a copy of my high school/home school curriculum including graduation requirements upon request
to maintain a GPA of 2.5 at BRISTOL to continue in the Dual Enrollment Program
to self-pay if my family does not qualify based on the Federal Income Guidelines set forth on page 2, unless
otherwise enrolled into a contract course or has approved Bristol waiver.
I certify that the information that I have provided in this application is accurate and complete. Further, by signing this form, I
agree to abide by all the rules and regulations and the student code of conduct of Bristol Community College. I also consent to
the reproduction and/or use of photographs of me in catalogs or other publications and in all forms of media and in all manners
including display, editorial, art and exhibition unless the “no” box is checked. No
Signature of applicant: __________________________________________ Date:
V.10/2019 Page | 1
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______________________________ ___________________________ ____________
FINANCIAL ELIGIBILITY FORM
Student Name (please print legibly): ______________________________________________________________
Parent/Guardian Name (please print legibly): _____________________________________________
All information on this form is REQUIRED to process the application for Dual Enrollment. Please select family unit size AND
family income level below. Do not leave blank, otherwise the application will be deemed incomplete.
Federal Current-Year Low-Income Levels (Effective January 11, 2019 until further notice)
Size of Family Unit
48 Contiguous States, D.C., only
□ 1
□ $18,735
□ 2
□ $25,365
□ 3
□ $31,995
□ $38,625
□ 4
□ 5
□ $45,255
□ $51,885
□ 6
□ 7
□ $58,515
□ $65,145
□ 9
□ Income Exceeds Federal Poverty Index
For family units with more than eight members, add the following amount for each additional family member: $6,630 for the
48 contiguous states, the District of Columbia, and outlying jurisdictions. The term "low-income individual" means an
individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.
MA Residents: The MA Department of Education and Secondary Education considers a student economically
disadvantaged if he/she participates in one or more of the following state-administered programs: the Supplemental Nutrition
Assistance Program (SNAP); the Transitional Assistance for Families with Dependent Children (TAFDC); the Department of
Children and Families’ (DCF) foster care program; and MassHealth (Medicaid).
Parent/ Legal Guardian Signature:
Signature indicates approval for minor to register for college courses. I certify that the above financial information is true and
accurate. I agree that if deemed ineligible for a free course, □I will self-pay □I do not wish to self-pay □Contract Course
Signature Relationship Date
V.10/2019 Page | 2
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The Bristol Dual Enrollment Application Here (Bristol Community College)

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Completed 17 September 2020

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