Www.cwu.edu
Please mail completed application to:
Central Washington University
Running Start Program
400 East University Way
Ellensburg WA 98926-7433
CWU ID
__________________________________________________________________________________________________________________________________________________________________________________________
PERSONAL INFORMATION Male Female
Circle: What year are you in high school now? Sophomore Junior Senior Circle: Term applying for: Fall Winter Spring
Have you earned college credit through CWU or any other institution? No Yes- Please list____________________________________
Public high school you will be enrolled in during Running Start: __________________________________________________________
Last Name ____________________________ First Name_______________________ Middle Name______________________________
Social Security Number ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Mailing Address _________________________________________________________________________________________________
Number and Street / PO Box Apt.# City State Zip Code
Telephone (_____) ___________________________________ Student Cellular Telephone (_____) _________________________
Student Email * _____________________________________ * upon admission students must create an CWU email account
Date of Birth _______________________________________ Birth place _____________________________________________
Month Day Year City State Country (if other than U.S.)
___________________________________________________________________________________________________________________________________________
ETHNICITY (OPTIONAL) (Required for State and Federal Statistics and requested on a voluntary basis. Answers will remain confidential)
White Black/African America American Indian or Alaska Native -Name of enrolled or principal tribe ___________________________________
Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Pacific Islander
No, not Spanish/Hispanic/Latino Yes, Mexican or Mexican American (Chicano) Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino
__________________________________________________________________________________________________________________________________________
FAMILY INFORMATION
INFORMATION FROM EDUCATIONAL RECORDS (DISCLOSURE AND CONSENT)
The Federal Educational Privacy Act (FERPA) restricts disclosure of educational records
I consent to the disclosure of my educational records by Central Washington University, which contains information pertaining to my enrollment in University courses and my academic progress in those courses as provided in this consent.
Information may be disclosed to my parents or guardians and appropriate high school and high school district officials for the following purposes:
• To inform them of the potential costs associated with enrollment in University courses when they may be financially responsible.
• To inform them of my progress towards high school graduation (Information could include: grades, student account information, fees, payments, and academic record information etc.)
Student Signature_______________________________________________________________________Date____________________
This release will be on file the entire length of time you are a CWU Running Start student. Please notify our office in writing if any names listed on the front page are no longer eligible to receive information outlined above.
RUNNING START FUNDING LIMITS
The student is responsible (not the high school or college) for maintaining
a schedule that stays within the Running Start funding limits or the student
agrees to pay all university costs incurred for exceeding the funding limit.
If the student enrolls for more university credits than allowed according
the Running Start Funding Limit Table, the student is responsible for:
• Paying all university costs associated with exceeding the limit
• Withdrawing from the excess university or high school course(s)
We (Student and Parent) acknowledge, with our signatures below, that we have read, understand and will comply with the conditions of Running Start participation and the expectations of university course enrollment.
|Student |Parent |
| | |
| | |
|Date___________________ |Date___________________ |
| | |
|Student Signature_________________ |Parent Signature__________________ |
| | |
|Student Printed Name________________ |Parent Printed Name_________________ |
| | |
Disability Accommodations & Disclosure: Postsecondary education institutions may set their own requirements for disabilities documentation so long as they are reasonable and comply with Section 504 and Title II. It is not uncommon for documentation standards to vary from institution to institution. A student must provide documentation, upon request, that he or she has a disability, that is, an impairment that substantially limits a major life activity and that supports the need for an academic adjustment. Institutions of postsecondary education are not required to conduct or pay for an evaluation to document a student’s disability and need for an academic adjustment. An IEP or Section 504 plan is generally not sufficient documentation to support the existence of a current disability and need for an academic adjustment from an institution of postsecondary education.
CWU provides equal opportunity in education without regard to race, color, creed, religion, national origin, sex, age, marital status, disability or status as disabled veteran or Vietnam-era veterans in accordance with institutional policies and applicable federal and state statutes and regulations
-----------------------
CWU ID:
(optional)
Mother or legal guardian
Name ______________________________________________________
Last First
Telephone (_____) ____________________________
Work Phone (_____) _______________Cell (_____) ________________
Address ____________________________________________________
Number and Street
______________________________________________________________________________
City State Zip Code
Email ______________________________________________________
If parent, has she received a Bachelors or higher? [pic] Yes [pic] No
Has she attended Central Washington University? [pic] Yes [pic] No
Father or legal guardian
Name ________________________________________________
Last First
Telephone (_____) ______________________________________
Work Phone (_____) ______________Cell (_____) ____________
Address _______________________________________________
Number and Street
______________________________________________________________________
City [pic]
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Email ________________________________________________
If parent, has he received a Bachelors or higher? [pic] Yes [pic] No
Has he attended Central Washington University? [pic] Yes [pic] No
______________________________________________________________________________________________________________________________________________________________________________________
APPLICATION REQUIREMENTS
1. Copy of High School transcript & Copy of College transcript if applicable
2. SAT, ACT or ACT Residual test scores
3. Signature of Public High School Counselor verifying student grade level as indicated in the Personal Information above.
Date___________________ Public High School Counselor Signature______________________
Counselor Printed Name___________________
[pic]
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