Application - Middlesex County College

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Middlesex County College
High School Scholars Program
Middlesex County College High School Scholars:
• Experience college work while still in high school.
• Earn college credits that will appear on a Middlesex County College transcript and may be accepted by other colleges.
• Explore different fields of study.
Who can qualify?
• Middlesex County high school students, who have completed the necessary prerequisites required with a grade of “C” or better, may
enroll as a Middlesex County College High School Scholar. Prerequisites are listed within individual course descriptions. Please see
the chart below for High School Scholars tuition/fee information.
When are classes held?
• Students may take regularly scheduled classes during the Fall and Spring semesters only. Students interested in enrolling in Summer
courses must complete and submit the Summer Program For High School Students Joint Enrollment Application and High School
Scholars Summer Registration form. Courses are listed in the Middlesex schedule of courses online at www.middlesexcc.edu.
How do I apply?
• Meet with your guidance counselor; review the Middlesex course schedule; choose the course you want to study.
• Complete the Registration form on the next page and the Application for Middlesex County College High School Scholars Program
on the reverse side.
• Ask your guidance counselor and your parent or guardian to complete and sign the indicated sections of the High School Scholars
application.
• Submit all completed forms with payment (Please make checks payable to Middlesex County College) directly to:
Middlesex County College - Office of School Relations
2600 Woodbridge Avenue
P.O. Box 3050
Edison, New Jersey 08818-3050
* The College Placement Test and/or official SAT scores are required for some courses. Visit the MCC Testing Center’s website at
http://www2.middlesexcc.edu/admissions/testing-center for more information.
Students may obtain their official SAT scores through the College Board website: http://www.collegeboard.org/
Grade and Transcript Information:
•If you wish to have a copy of your transcript sent to your guidance counselor or college you will be attending, please complete a
transcript request form available at the Office of the Registrar or online at www.middlesexcc.edu
•Grades are generated and posted at the end of the semester. Once grades have been posted, they may be viewed on Campus
Cruiser/Web Advisor. Login and password information are mailed upon completion of registration.
•Note: The grade you receive for the course will remain on your permanent record at Middlesex County College.
HIGH SCHOOL SCHOLARS TUITION/FEE INFORMATION
(Note: Textbooks are additional)
Course(s) taken:
at Middlesex County College
at Student's High School
during Summer Session
by Out-of-County Residents
1st Course
Full Tuition/Fees*
$155.00*
Full Tuition/Fees*
Full Out-of-County
Tuition/Fees*
Each Additional Course
Full Tuition/Fees*
$155.00*
Full Tuition/Fees*
Full Out-of-County
Tuition/Fees*
*Please reference the MCC website and/or Course Catalog for current tuition/fees as rates are subject to increase.
Any questions? Please call 732.906.2513. Fax: 732.906.7709.
Applications for the Fall semester are accepted as of May 1. Applications for the Spring semester are accepted as of November 1.
Early applications are encouraged, as classes tend to fill quickly. Deadlines and late fees apply.
Check the website at www.middlesexcc.edu.
HIGH SCHOOL SCHOLARS REGISTRATION FORM
Check Name or Address Change:
COMPLETE ALL INFORMATION BELOW (PLEASE PRINT)
CHECK ONE:
SOCIAL SECURITY #:
FALL
SPRING
SUMMER Year: _____________
______________________________
Name
Address
(Or MCC Student ID#)
ARE YOU A NON-RESIDENT ALIEN? _____ YES _____ NO
TIN NUMBER_________________________________________
NAME: _______________________________________________________________________________________________________________________________
Last
First
Middle Initial
ADDRESS: ____________________________________________________________________________________________________________________________
Street
___________________________________________________________________________________________________________________________
City
State
County
Zip Code
TELEPHONE: (_________) - ____________-________________
E-MAIL: _______________________________________________________________
DATE OF BIRTH _______________________________________________________________
______________________________________________
Graduation Date
_______________________________________________________________________________
Name of High School
_____________________________________________
Present Grade Level
_______________________________________________________________________________
Middlesex County College course for which you are currently registering
_____________________________________________
Semester
*List COMPLETE course code and section number.
Note: If you wish to register for a course on an audit basis (no credit, no grade), place the letter X in the “Credits” section below.
*COURSE
CODE
Example:
ENG 12X
*SECTION
NUMBER
0X
COURSE TITLE
CREDITS/
(AUDIT = X)
Course Title
3
Total :
I, ____________________________________________________________, hereby grant approval for Middlesex County College to release grade and other
information in my education record pertaining to my participation in the High School Scholars Program to my parent(s) or guardian(s).
Student Signature: _________________________________________________________
Date: _______________________
Students with disabilities may access accommodations through the College’s Disability Services Office. Please call 732.906.2546 to self-identify and request a
Disability Service’s application and procedures. Please note that Disability Services at the collegiate level differ greatly from High School Special Education, the IEP is
not applicable to College.
PARENTS/GUARDIANS PLEASE NOTE: Students will be taking classes on a college campus in an unsupervised, open environment. We recommend door-to-door
pick up and delivery of all high school students. Please be advised that books are required for the first day of class and can be purchased at the College Bookstore on
campus or online at www.bluecoltbookstore.com
Students under the age of 17 who wish to participate in off-campus events for which transportation is provided must be accompanied by an adult.
OPTIONAL INFORMATION:
GENDER:
Male
Female
RACE/ETHNIC GROUP:
This information will be used only for the preparation of state and federal reports and for special interest and activity mailings. This information will not have any effect on the admissions
decision.
Hispanic (of any race)
Asian
Native Hawaiian (or other Pacific Islander)
Two or more races
American Indian or Alaska Native
Black or African American
White
APPLICATION FOR HIGH SCHOOL SCHOLARS PROGRAM
This form is to be completed by high school students wishing to enroll in a course at Middlesex County College in the Fall or Spring semester.
The College Placement Test and/or official SAT scores* are required for some courses.
Visit the MCC Testing Center’s website at http://www2.middlesexcc.edu/admissions/testing-center for more information.
*Students may obtain their official SAT scores through the College Board website: http://www.collegeboard.org/
COMPLETE ALL INFORMATION BELOW (PLEASE PRINT)
SECTION I: GENERAL DATA – STUDENT INFORMATION
NAME: _____________________________________________________________ SOCIAL SECURITY #: _________-_______-__________
ARE YOU A NON-RESIDENT ALIEN? _____ YES _____ NO
TIN NUMBER____________________________________
ADDRESS: _____________________________________________________________________________________________________________
Street
_____________________________________________________________________________________________________________
City
State
County
Zip Code
TELEPHONE: (_________) - ____________-_______________ E-MAIL: ______________________________________________________
DATE OF BIRTH _______________________________________________________________
________________________________
Graduation Date
_______________________________________________________________________________
Name of High School
________________________________
Present Grade Level
_______________________________________________________________________________
Middlesex County College course for which you are currently registering
________________________________
Semester
Why did you decide to take a class at Middlesex County College this semester? (Please check one)
Need credits to graduate
Personal enrichment
Academic advancement
Audit
Other : ______________________________________________________________________________________________________________
SECTION II: PARENTAL APPROVAL – (To be completed by parent or guardian)
I hereby grant approval for __________________________________________________________________, to enroll at Middlesex County College
Student’s Name
for the course listed in Section I.
Parent/Guardian’s Name (please print): ___________________________________________________
Signature: ____________________________________________________________________________
Date: _______________________
SECTION III: HIGH SCHOOL GUIDANCE COUNSELOR APPROVAL
To the guidance counselor: High School students may be accepted into a part-time program of study only on the basis of academic ability and
emotional maturity as attested to by the student’s guidance counselor. If you support this individual’s application, please sign below. Feel free to
expand upon your recommendation and share any additional information with us regarding this student.
I hereby grant approval for ____________________________________________________________, to enroll at Middlesex County College
Student’s Name
for the course listed in Section I and certify that this student is an eligible high school student and has met the prerequisite(s) for this course.
Counselor’s Name (please print): __________________________________________________________
Signature: _____________________________________________________________________________
Date: _______________________
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