Dual Enrollment Senior Year Option Program by nAnN0r


									                                                                                       Dual Enrollment Senior Year Option Program
                                                                                        Application & Student/Parent Agreement
     P.O. Box 3300, Somerville, New Jersey 08876-1265
     (908) 526-1200  website: http://www.raritanval.edu
    Social Security Number                       Legal Name (Last, First, Middle)                                                           Former names

    Permanent Home Address (not PO Box)(include apt. #)                        City                        State            Zip             County                    Country

    Mailing Address (if different from above)                                  City                        State            Zip             County                    Country

    Home Phone Number                                                                  Email Address

    Name of High School                                                         City                               State           Zip                    Date of Graduation

    Ethnic Status (check one)                                                            Gender (circle one)                Are you a citizen of the United States?
                                                                                                                                                      (circle one)       Yes        No
    ____ Black/African-American (Non-Hispanic)   ____ American Indian/Alaska Native          Male              Female

    ____ White/Caucasian (Non-Hispanic)          ____ Asian/Pacific Islander             Birth date:   (Month, Day, Year)         Please note that data on ethnic status, gender, and
                                                                                                                                  birth date are optional.
    ____ Hispanic/Latino                         ____ Other                              ____________ , ______ , ________

To qualify for the RVCC Dual Enrollment Senior Year Option Program, students must:
      Have successfully completed the HSPA and need to complete State high school requirements.
      Have successfully met all requirements for Senior status and have the grade point average (GPA) established by the high school.
      Be academically motivated, based on teachers’ or guidance counselors’ input.
      Take the RVCC placement test in reading, writing or mathematics, if enrolling in an English or Math course. Exemptions:
       Students with a 530 on the Verbal portion of the SAT are exempt from taking the writing and reading portion of the test.
       Students who score 3,4, or 5 on the AP Calculus BC Exam, or receive a minimum grade of 70% on the RVCC Unified Calculus
       II Department Exam, do not have to take the math portion of the test, if enrolling in Calculus III and Differential Equations.
       Students enrolling in a language course, not already taken in high school, do not take the RVCC Placement Test in foreign

Attendance Policy
Students enrolled are expected to attend all classes for every course in which they are registered. Only illness, observance of religious
holidays, or serious personal matters may explain an absence. To provide for these, a student is entitled, without question, to absences
amounting to the equivalent of one week’s class time. Any absences in excess of that are handled individually by each instructor. It is
the prerogative of the instructor to make exceptions for valid reason, provided the student will be able to fulfill the course requirements.
At the instructor’s option, absences in excess of one-fifth of the semester’s lecture or lab classes may result in administrative withdrawal
of the student without prior notice or refund.

Student Records
The Family Educational Rights and Privacy Act protects educational records, and the sole right to review and inspect those records
belongs to the student, regardless of age. At the end of the course or semester, a grade will be posted to the student’s RVCC transcript.
To obtain an official transcript, students must submit a requesting letter with their signature, accompanied by the five dollar transcript
fee made payable to the RVC College.

By signing below, we certify that all information provided on this form is complete and accurate. We have read and agree to abide by
the above program requirements. We will acquaint ourselves with and abide by the student code of conduct and other policies
governing the academic and social standards of Raritan Valley Community College. We authorize RVCC to send the student’s grades to
the above high school.

Student Signature           ________________________________________________________ Date _______________
Parent/Guardian Signature                 __________________________________________________ Date ________________
I hereby recommend the above named student to participate in the Dual Enrollment Senior Year Option Program.
Guidance Counselor Signature _______________________________________________ Date_________________

Return this completed form with a $25 application fee to the designated high school representative. Checks made payable to RVC College.

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