START COLLEGE NOW. Admissions Packet Checklist

Transcription

1 Admissions Packet Checklist For acceptance into the Start College w (SCN) program at Blackhawk Technical College, the following items are to be submitted together by the Start College w student. If an individual item is turned in to the College, it will be returned to the student. ALL of the following application materials must be submitted at one time and must be turned in by April 15 for the fall semester and vember 15 for the spring semester: Completed Start College w Application for Admission Official copy of high school transcript Release of Student Records Form, signed by the Start College w student WTCS form- Completed and signed by school official Statement of Understandingsigned by Start College w student The completed application packet should be dropped off or mailed to: Blackhawk Technical College Start College w, Admission Office 6004 S. County Road G P.O. Box 5009 Janesville, WI Complete pre-admission testing: ACCUPLACER- Offered on Central Campus Walk-in hours are posted on blackhawk.edu. appointment is necessary. To schedule an evening or Saturday test, call (608) , OR ACT or SAT. Submit your official copy of scores or request scores from ACT or SAT. AFTER you submit the completed application packet and complete the pre-admission testing, WATCH YOUR MAIL! 1. You will receive a letter of acceptance to the college. 2. Attend an advising and registration session. You will not be able to register for classes until you meet with your advisor. Register for classes. Acceptance into the college does not guarantee a seat in the class- you must register! 3. Questions about your application? Please contact: Rini De Alwis High School Outreach Specialist ddealwis@blackhawk.edu (608) In addition to the materials above, the Start College w student also needs to complete pre-admission testing. Testing can happen separately from submitting the above materials, but the student will not be accepted to the College for Start College w until testing is complete. Minimum assessment scores are required for some programs.

2 Application For Admission Legal name: Last First Middle Former last name(s) (if applicable) Permanent address Street or R.F.D. Box number City State Zip Code Mailing address (if different) Street or R.F.D Box number City State Zip Code Phone number Other/Mobile phone number address 9. Gender: Male Female 10. Date of Birth (MM/DD/YY) 11. Are you a U.S. Citizen? If no, then are you in the U.S. on a Visa? Are you a permanent resident? If you are not a U.S. Citizen or Permanent Resident, please provide: Visa Type Visa. 12. I am a legal resident of: City/Village/Township (circle one) City/Township County State 13. Name of high school district in which you now reside The following questions are confidential. Your responses will help the technical college evaluate recruitment and retention practices and will not affect admission to the college. Question 14(a) and 14(b) relate to racial and ethnic identity. Please respond to both questions. 14(a). Are you Hispanic or Latino (a person Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race)? 14(b). Select another group or groups that apply to you. American Indian or Alaska Native. A person whose ancestors include native peoples of rth and South American (including Central America), And who maintains a tribal affiliation or community attachment. Asian. A person whose ancestors include native peoples of the Far East, Southeast Asia or the Indian subcontinent (including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam). Black or African American. A person whose ancestors include an of the black racial groups of Africa. Native Hawaiian or other Pacific Islander. A person whose ancestors include the native peoples of Hawaii, Guam, Samoa or other Pacific Islands. White. A person whose ancestors include native peoples of Europe, the Middle East or rth Africa. 15. Have either of your parents completed a four-year college degree or beyond? 17. I wish to attend Blackhawk Technical College at Campus. 18. Have you attended this college before? If yes, last year and semester attended. 19. Semester you wish to begin: Fall Winter/Spring Year 20. Program/major choice Program code # (if known) 21. Name of high school City State 23. Have you taken a high school course for technical college credit? (Youth Apprenticeship, Certified Nursing Assistant, Certified Co-ops) (transcript or certificate required for verification) 24. Circle highest grade completed: I certify that the information on this application is true and complete to the best of my knowledge. I understand that the completion of this application and admission to the college does not guarantee me a space in specific course(s). I understand that after acceptance to BTC, I must register for particular courses. The purpose of this is form is for processing purposes only. Date: Signature 02/06/18 ak

3 Confidential Information Release Authorization OFFICE OF THE REGISTRAR 6004 S County Road G, PO Box 5009, Janesville, WI (608) fax (608) RELEASE OF START COLLEGE NOW/YOUTH APPRENTICESHIP STUDENT RECORDS I,, BTC Student ID#, authorize Blackhawk Technical College to release information concerning the following student records: (check all that apply) Any and all records Academic records: grades, transcripts, admissions records, course schedule, etc. Student account records Other records (specify): Release the designated information to: Parents or Guardian (Enter their names) High School Staff at I further authorize Blackhawk Technical College representatives to discuss my student records with the above named designee(s). I will not hold Blackhawk Technical College liable under the Family Educational Rights and Privacy Act (FERPA) for releasing my student records to the above named designee(s). This release will remain in my record and will be in effect for one year from the date indicated below. (Print Student Name) (Student Signature) Dated:

4 Statement of Understanding-TO BE RETURNED TO BTC STATEMENT OF UNDERSTANDING After reading the attached packet and the BTC Student Handbook (found at under Students, Student Handbook ) sign and submit this page with your Start College w (SCN) Admission Packet. I have read and understand the responsibilities for the student, parent/guardian, high school and Blackhawk Technical College in regards to Start College w. I agree to follow the Start College w Guidelines set forth by the Blackhawk Technical College, the school district, and the Wisconsin Department of Public Instruction. I also agree to follow the expectations for Blackhawk Technical College students, which are explained in the BTC Student Handbook. Student Signature: Date: Parent/Guardian Signature: Date: Include this signed form with your Start College w Admission Packet. Drop off or mail your completed SCN packet to: Blackhawk Technical College Start College w, Admission Office 6004 S. County Rd. G PO Box 5009 Janesville, WI

5 APPLICATION I. STUDENT INFORMATION This section completed by student / parent Student Name First, Middle, Last Student s Birthdate Mo./Day/Yr. Gender Parent/Guardian Name First, Last M F Other Address Street, City, State, Zip, County Student Phone Area/. Student Parent/Guardian Phone Area/. Parent/Guardian High School Student Attends & Projected Graduation Year School District in Which Student Resides Technical College to Which You Are Applying to Semester for which applying: Spring Fall Year 20XX Check if Alternate Technical College Course Name Grade Student Will be in When Taking These Courses Technical College Course Number of College Credits Comparable HS Course Offered? Number of College Credits Earned to Date II. BOARD ACTION Completed by HS district Approved for HS Credit. of HS Credits III. STUDENT & PARENT / GUARDIAN SIGNATURES This section completed by student / parent STUDENT SIGNATURE IN SIGNING THIS DOCUMENT, I acknowledge the following: I understand and will comply with the assurances and conditions outlined in Student/Parent Specific Responsibilities and Subchapter (14). I authorize the high school and technical college to share course and grade information. Student Signature Required PARENT/GUARDIAN SIGNATURE Required if student is under 18. I understand and will comply with the assurances and conditions outlined in Student/Parent Specific Responsibilities and Subchapter (14) I authorize the high school and college to share course and grade information. Parent/Guardian Signature Required

6 Student Name First, Middle, Last IV. STUDENT NAME This section completed by student / parent V. HIGH SCHOOL BOARD APPROVAL This section completed by district Named student is approved to enroll for courses marked Approved in Section III:. If no, indicate reason for denial: Check if student has a record of disciplinary issues. Name of High School Board Approval Authority Phone Area/. High School Board Approval Authority Signature Name of Course(s) in Which Student is Enrolled VI. TECHNICAL COLLEGE APPROVAL This section completed by college Course Code(s) / Number(s). of College Credits District Approved? Eligible to enroll I CERTIFY that the above-named student is eligible to attend the course(s) listed in Section VI and that all these courses are nonsectarian in content. The student will be notified of college admission policies/criteria and record disclosure provisions. The technical college agrees to provide the school district with grade information (and attendance information upon request). t eligible to enroll I CERTIFY that the above-named student is not eligible to enroll in and/or attend the course(s) listed in Section VI. The student will be notified of the reasons for ineligibility. Name of Technical College Representative and Title Phone Area/. Technical College Representative Signature VII. APPEALS Appeals of school board decision: A student may appeal a school board decision regarding awarding of high school credit or course comparability to the State Superintendent within 30 days of the board s decision. Page 2 of 2