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 language. 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. Agreement 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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