College-Wide Dual Enrollment Application/Registration Form ...
2016-2017 Dual Enrollment Application/Registration Form for Classes Taught in High School
BCC ID. No. ___________if available Email: __________________________________ ___________________________________
(please print email address clearly)
__________________________________________________________________________________________ _ _____ ______
Last Name First Name Middle Male Female
________________________________________________ _____/_____/_____ *___________/________/____________
Street Address Birth Date Social Security Number *Required
______________________________________________________________ ________ __________________________________
City, State, Zip Code Phone Number
______________________________________________________________ ___________________________________
High School Name Expected H.S. Graduation Date
|High School Class /Teacher |College Class (Example: US HISTORY I - HIS-111) |Credits * |
|1111111. | | |
|2222222. | | |
|3333333. | | |
|TTTTTT Total Credits | | |
2016-2017 tuition rate per credit hour = $69.25
(2 credits--$138.50+ $15 reg. fee = $153.50) (3 credits--$207.75 +$15 reg.fee = $222.75)
(Math and Science courses are 4 credits --$277.00 + $15 reg. fee = $292.00) Reg. Fee $15 – Per year not per course
|Total number of credits ________ | |
|X credit rate of $69.25 | |
|+ Registration fee (per year) $15.00 | |
| Total | |
|(Check or Money Order Attached) | |
Please make check/money order to: Bergen Community College (no cash accepted)
All grades will be reflected on a Bergen Community College transcript.
Approval and permission is granted for this student to participate in the Dual Enrollment Program. Pre-requisites for English and mathematics must be met.
____________________________________ ______________ _____________________ ____/____/____ Signature - Guidance Counselor Title Date
___________________________________________________ _____________________ ____/___/_____
Signature – Administrator or Instructor Title Date
I understand that this form is to apply for dual enrollment credits at Bergen Community College for class/s taught in the High School. I certify that all information provided here is true and correct to the best of my knowledge.
__________________________________ ____/___/_____ ____ __________________________ ____/____/___
Signature of Student Date Signature of Parent or Legal Guardian Date
Please indicate if you previously registered for a dual enrolled course at BCC with a Yes or No __________
Transfer of Credits to NJ schools – Out-of-State Schools – check Transfer Policy
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