MEMORANDUM
To:
Prospective Dual Enrollment Students and Parents
From:
Ann Kelley-Spence,
Enterprise State Community College Dual Enrollment Contact
Thank you for your interest in dual enrollment courses offered by Enterprise State Community College (ESCC). Your decision to pursue college credit
while in high school will give you a “jump start” on your postsecondary education and your career.
Enclosed with this memorandum are several forms that you will need to complete before you can participate in a dual enrollment class:


Accelerated Credit/Dual Enrollment Application for Admission (online applications are not accepted for Dual Enrollment)
Certification of Eligibility for In-State Residency
In addition to the above forms all students MUST complete a W9S Form. Listed below are instructions for completing the W9S.
 W9S Form - The IRS requires all educational institutions to have a correct social security number (SSN) or, if not eligible to obtain an SSN,
an individual taxpayer identification number (ITIN) on file for all students. Educational institutions must file information about qualified tuition
and related expenses (Form 1098-T, Tuition Statement) and to furnish a statement to you. Please read the following instructions before
completing the W-9S Form.
INSTRUCTIONS:
1. Download the fillable W-9S Form from our website - www.escc.edu, Admissions tab, forms - (Only fillable when using Internet Explorer or Google
Chrome.)
2. Complete PART I of the W-9S Form and save it to your computer.
 THIS FORM MUST BE TYPED.
 HAND WRITTEN FORMS WILL NOT BE ACCEPTED.
 NAME AND SOCIAL SECURITY NUMBER MUST BE ENTERED AS IT APPEARS ON YOUR SOCIAL SECURITY CARD.
3. Send the W-9S Form to ESCC via ONE of the following methods:
 Email: w9sform@escc.edu
 Mail: Enterprise State Community College, Office of Admissions, ATTN: Joey Holley, P.O. Box 1300, Enterprise, AL 36331
 Hand Deliver: Lurleen B. Wallace Hall (Student Center), Office of Admissions, ATTN: Joey Holley, 600 Plaza Drive, Enterprise, AL
Also, please include a photo ID and an official transcript of high school grades.
For high school students to enroll in dual credit courses, the following requirements must be met.
Requirements are:
 3.0 GPA and maintain for academic courses
 2.5 GPA and maintain for technical courses
 All students must take the COMPASS test or have taken the ACT and meet the minimum cut scores. COMPASS can be taken at
any ESCC/AAC location by appointment.
Please return completed forms to your high school counselor or mail to:
Enterprise State Community College (ESCC)
P.O. Box 600
Enterprise, AL 36331
Attn: Ann Kelley-Spence
I look forward to having you as a dual enrollment student with our college. If you have questions or need any assistance, please call (334) 347-2623,
ext. 2208 or email akelley@escc.edu
Enterprise State Community College will not officially award college credit to high school students until proof of high school graduation (an
official transcript with a graduation date) or an official GED certificate.
www.escc.edu • (334)347-2623 • 600 Plaza Dr • Enterprise, AL 36330 • facebook.com/weevils • @EnterpriseState
Enterprise State Community College
Alabama Aviation Center
Dual Enrollment Application
This application is for dual enrollment purposes.
Once you have graduated high school, you must complete ESCC’s re-admit form to be admitted as a college student.
Please Print
Legal Name:
First
Middle
Social Security Number
Last
Date of Birth
/
/
Home Number
(
)
-
Cell Number
(
)
-
Mailing Address
City
State
Zip Code
Name of High School:
Term: Fall
EMAIL:
Spring
Summer
Year: ______________
Current Grade Level
10th
11th
12th
Expected High School Graduation YEAR_________________
If attending dual enrollment classes other than at your high school, check location below:
Enterprise
Ozark
Mobile
Albertville
Andalusia
Headland
Mobile
Other_____
Gender:
Male
Female
Are you a United States Citizen?
Yes
Ethnicity: Are you Hispanic or Latino? Yes
No
Please choose one or more of the categories listed below:
Race: Black
Asian
Native American Indian/Alaska
White
Hispanic
Hawaiian/Pacific Islander
No
Are you a resident of the State of Alabama?
Yes
No
Enterprise State Community College Equal Opportunity in Education
It is the official policy of the Alabama State Department of Postsecondary Education and Enterprise State Community College that no person in Alabama shall, on the grounds of race, color,
disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity. Enterprise State
Community College complies with non-discriminatory regulations under Title VI and Title VII of the Civil Rights Act; Title IX Educational Amendment; section 504 of the Rehabilitation Act;
Americans with Disabilities Act. Any student requiring special accommodations under ADA should contact the College ADA Coordinator.
I certify that the information contained in this application is true and correct. I understand any misstatement of facts may result in disapproval of this application
or expulsion from Enterprise State Community College if discovered after admission.
___________________________________________________________________________________________________________________________________________
ENROLLMENT AUTHORIZATION
I, the student, understand the course(s) I am enrolling in is/are a college level class, and that the grade earned will appear on my permanent college
transcript. I authorize Enterprise State Community College to enroll me in the course(s) listed below. I also understand and accept the high school
equivalency listed.
ESCC Course (e.g. ENG 101)
Course Title
High School course Equivalent
Unit(s)
_________________________
___________________________
__________________________
___________________
_________________________
___________________________
___________________________
___________________
_______________________
___________________________
__________________________
___________________
Student Agreement: I have read, understand and agree to the above statements and authorize (High School) ______________________________________________
to release my grade/transcripts to the college named above.
_________________________________________
Student Signature
_____________________________________
Printed Name
_______________________
Date
PARENTAL AUTHORIZATION
I, the parent/legal guardin of this student, grant permission for my son/daughter to enroll in the coure(s) listed. I understand the unique character
and rigorous requirements of the coure(s). I authorize __________________________________ High School to release my child’s grades/transcript
to the college and to enroll my son/daughter in the course(s).
___________________________________________________
Parent/Guardian Signature
________________________________________ __________________________
Printed Name
Date
PRINCIPAL/SUPERINTENDENT AUTHORIZATION
The above student is authorized and recommended to enroll in the course(s) listed for the semester(s) noted. By signing the consent form
I/designee have assessed the student’s preparedness to undertake college level studies in this subject and are recommending the student for
attendance in the Dual Enrollment/Dual Credit program. I/designee have verified this student is enrolled in or has completed the 10th grade at
_____________________________ High School and has a minimum cumulative 3.0 grade point average (2.5 if enrolling in career technical dual
enrollment courses only) on a 4.0 scale in high school courses or in career/technical education courses directly related to the postsecondary
technical courses in which the student intends to earn dual credit, if applicable. (Note: State Board of Education policy requires that dual
enrollment or accelerated credit students be enrolled in grades 10, 11, or 12.) I hereby recommend that this student be admitted to the dual
enrollment/dual credit program at Enterprise State Community College.
__________________________________________________
Principal Signature
Date
______________________________________________________
Superintendent Signature
Date
********************************************************************************************************************************************************************************************************
College President’s Signature_______________________________________________________
Date______________________________
FOR ESCC DUAL ENROLLMENT OFFICE USE ONLY
Date Processed: ______________
Processed by: _____________
High School GPA: ___________________
Approved: _________________
Online applications are not accepted.
THE ALABAMA COLLEGE SYSTEM
CERTIFICATION OF ELIGIBILITY FOR IN-STATE RESIDENCY
Student Name______________________________________________________ SSN____________________________
Street Address______________________________ City____________________________ State__________ Zip________
Home/Cell Phone ___________________ Birthday____/____/____ Semester
Fall
Spring
Summer Year___________
In order to be eligible for in-state tuition, you MUST complete this form and fall into ONE or more of the following categories:
1. BE A LEGAL RESIDENT OF THE STATE OF ALABAMA:
Yes
No
I (or my non-estranged spouse) have lived in the State of Alabama for at least 12 months immediately preceding my application
for
admission.
I am a dependent student and my parent/legal guardian has lived in the State of Alabama for at least 12 months.
2. BE A NON-RESIDENT WHO MEETS THE QUALIFICATIONS FOR IN-STATE TUITION
I am applying for consideration of in-state tuition for the following reasons:
I (or my supporting spouse or parent) am a member of the United States Military on full-time active duty and is stationed in
Alabama
under orders for duties other than attending school.
I (or my supporting spouse or parent) am an accredited member of a consular staff assigned to duties in Alabama.
I (or my supporting spouse or parent) have full-time employment in Alabama and will start said employment within 90 days of my
registration.
I (or my spouse) am a full-time permanent employee of this institution.
I reside in a county of a state which is within the 50-mile radius of the designated campus of this institution.
Enterprise/Ft Rucker: FL
(GA)
Ozark: GA
Seminole
Ozark: FL
Mobile: MS
Mobile: FL
Jackson
Holmes
Okaloosa
Walton
Washington
Early
Clay
Miller
Quitman
Randolph
Holmes
George
Escambia
Jackson
Green
Santa Rosa
Walton
Harrison
Washington
Jackson
Stone
Early
Perry
3. HAVE SUBSTANTIAL CONNECTIONS
I have more substantial connections with the State of Alabama than with any other state. Check all that apply:
I attended/graduated from an Alabama High School.
I or my spouse/parents have paid Alabama State income taxes as a resident.
I or my spouse/parents own a residence or other real estate in Alabama and have paid ad valorem taxes in the state.
I am employed full time in the State of Alabama
I have previous periods of residency in the state continuing for one year or more.
I am a registered voter and have voted in Alabama.
I possess a state or local license to do business or practice a profession in Alabama.
I possess an Alabama license plate.
I have maintained continuous physical presence in Alabama for a purpose other than attending school, excluding temporary
absences
for travel, military service, and temporary employment.
I have membership in religious, professional, business, civic, or social organizations in Alabama
I have maintained a checking account, saving account, investment account, or safe deposit boxes in Alabama.
I have an in-state address shown on one or more of the following:
Selective Service Registration
Hunting or Fishing License
Driver’s License
Insurance Policies
Last Will and Testament
Annuities
Retirement Plan
Stock/Bond Registrations
Auto Title Registration
I understand that I may be asked to provide documentation to ENTERPRISE STATE COMMUNITY COLLEGE for items that I have checked.
I agree to notify the college if there are any changes in the information submitted with this form. I understand that an out-of-state student
cannot attain resident student status simply by attending school for 12 months in the State of Alabama.
Signature_________________________________________________________
Date: _____________________________________
Dual Enrollment
Authorization for Release of Records
According to the Family Educational Rights and Privacy Act of 1974 (FERPA), all rights of Access to
students’ educational records transfer from the parents to the students when the students become 18 years
of age OR are enrolled in a postsecondary education institution. To comply with the requirements of
FERPA, Enterprise State Community College shall obtain written consent from students before disclosing
any personally identifiable information from their education records.
As a participant in the accelerated credit or dual enrollment programs, I understand that
it is the responsibility of Enterprise State Community College to release this
information. My signature further verifies my understanding that, as a student at
Enterprise State Community College, I am subject to the same FERPA policies as
other students at the College and that I understand the policy as outlined below:
Enterprise State Community College shall obtain written consent from
students before disclosing any personally identifiable information from
their education records. Directory information will be released to inquiring
individuals or agencies unless students sign a “Do Not Release Directory
Information” form in the Admissions/Records Office during the first two
weeks of the term. This form must be resubmitted annually. Directory
information includes:
(a) name
(b) address
(c) telephone listing
(d) participation in officially recognized activities and sports
(e) major field of study
(f) weight and height of an athletic team member
(g) dates of attendance
(h) degrees/awards received
(i) date of birth
(j) most recent educational institution attended
(k) photographs
(l) enrollment status
(m) e-mail address
______________________________________
Student’s Signature
________________
Date
FERPA WAIVER
The Family Educational Rights and Privacy Act (FERPA) of 1974 insures students of the right to privacy
and confidentiality with respect to their educational records. With a student’s written consent, the
Registrar (or designee) may disclose any confidential information on file to any individual or agency
named by the student.
This form is provided as a means for students to give the Registrar (or designee) permission to discuss
their academic records with someone other than themselves (i.e., with a parent, guardian, etc.). This
information can only be given in person, not over the phone or email.
Written consent will be kept permanently on file, and the Office of the Registrar (or designee) will release
information regarding the student’s academic record to those person(s) who have been designated on this
form. If for any reason a student decides to cancel this release, he/she must submit a letter withdrawing
the consent, indicate the person(s) affected, and send or deliver the written notice to: Enterprise State
Community College, Office of the Registrar, 600 Plaza Drive, Enterprise, AL 36331.
I hereby authorize the Registrar (or designee) to release information regarding my academic
record to the person(s) whose name(s) appear below:
Disclose to: Name (Print):
Relationship to student:
Disclose to: Name (Print):
Relationship to student:
Disclose to: Name (Print):
Relationship to student:
Academic Records consist of grades, transfer information, financial aid information, academic transcript
and related records of academic standing.
______________________________
Student’s Name (print)
________________________
Student ID
Student’s Signature
Date
_______________________________
ESCC Employee witness to student signature
_________________________
Date