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)
________________
________________
_______________
_____________
__________
________________
________________
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_____________
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ALTERNATE COURSE REGISTRATION SELECTION(S): CRN Dept. & Curse # Section/Session Day & Time
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 : _______________________________________