Central Connecticut State University - Office of the Registrar High ...

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Dec 19, 2017 - Central Connecticut State University - Office of the Registrar. High School Dual Enrollment Registration
Central Connecticut State University - Office of the Registrar High School Dual Enrollment Registration Agreement This form is to be used by Newington High School students and must be completed in its entirety and submitted to the Office of the Registrar before the course(s) is taken. Please refer to the CCSU catalog at www.ccsu.edu/catalog for current policies, courses and prerequisites. Each semester’s course offerings can be found at: www.ccsu.edu/courses. S T U D E N T D A T A: Banner ID Number (currently / previously attended CCSU):

____

OR Social Security Number (new students only) Last Name

First Name

Street Address

M.I. Apt.#

City

State

Home phone

Zip Email Address

Date of Birth:

_/

/

 Male  Female

Sex:

US Citizen :

 Y  N

THIS INFORMATION IS REQUESTED FOR STATISTICAL PURPOSES ONLY; RESPONSE IS OPTIONAL.

What is your ethnicity? (Check one)

 Hispanic or Latino

 Not Hispanic or Latino

What is your race? (Mark one or more races to indicate what you consider yourself to be)  Asian  White

 Black or African American

PREFERRED COURSE REGISTRATION SELECTION(S): CRN Dept. & Curse # Section/Session Day & Time (Exp: 42373)

(AC 210)

# Credits

(01)

________________

________________

_______________

_____________

__________

________________

________________

_______________

_____________

__________

ALTERNATE COURSE REGISTRATION SELECTION(S): CRN Dept. & Curse # Section/Session Day & Time

# Credits

______________

______________

_____________

____________

_________

______________

______________

_____________

____________

_________

DUAL ENROLLMENT REGISTRATION POLICIES AND PROCEDURES       

Students enrolling must carry minimum high school GPA of 3.0. Students may enroll up to two evening courses for which they have satisfied all academic prerequisites. Enrollment is on space available basis. Registration will be confirmed by the Office of the Registrar. Approved registration requests should be submitted to CCSU no later than one week prior to the beginning of the semester. Per Board Resolution 11-56, students participating in this program will have the cost of tuition and fees waived. Students shall be responsible for purchasing all required course materials. Students are responsible for abiding by all other applicable CCSU policies during their period of enrollment. I authorize CCSU to release my transcript to Newington High School.

By signing below you acknowledge that you have read and understand the above policies and procedures.

S T U D E N T S I G N A T U R E:

DATE

H I G H S C H O O L A P P R O V I N G O F F I C I A L S I G N A T U R E : _______________________________________