DUAL ENROLLMENT Registration Steps Chandler-Gilbert Estrella Mountain GateWay Glendale Mesa Paradise Valley Phoenix Rio Salado Scottsdale South Mountain New Dual Enrollment students start with Step 1. Continuing Dual Enrollment Students, skip to Step 2. 1. GET ADMITTED 2. TAKE THE PLACEMENT TEST Create MEID (User ID) Account and Apply for Admission Log onto admissions.maricopa.edu and click START NEW APPLICATION. Follow the instructions. At the Welcome to the Student Admissions Application click GET STARTED, and follow instructions. Math and English Composition courses require a college placement test. Other courses may require a reading placement test. A college student ID number and picture ID is required for testing. Testing is offered at your high school, contact your high school. To prepare and study, review sample questions at accuplacer. collegeboard.org Please note: In order to complete your student admission application, you must click on after each page. You will be prompted to submit ID. Acceptable forms of identification: State-issued driver s license, identification card, instruction permit U.S. Passport or passport card High school ID and birth certificate (a hospital record/certificate and certified Abstract of Birth are not acceptable) 3. SUBMIT REGISTRATION FORM 4. SUBMIT FINANCIAL RESPONSIBILITY and CONSENT FOR STUDENTS UNDER THE AGE OF 18 FORM If you are under 18 years of age, you and a parent/guardian must complete and sign the form. 5. PAY TUITION AND FEES Please take note of your login (MEID), student ID number and password for future use. MEID (User ID): (Used for logging into Maricopa Student Tools) Student ID Number: (For registration, testing and academic support) Maricopa Email: (Activate your email at google.maricopa.edu. You are responsible for all communication in your Maricopa email. Please check often and keep your password in a secure place.) Maricopa Helpdesk: 1.888.994.4433 (for technical assistance) DID YOU KNOW... You can forward your Maricopa email to a personal email account (google.maricopa.edu) You can check your Message Center, class schedule, and payment information at my.maricopa.edu 7/26/2017
Financial Responsibility and Consent for Students Under the Age of 18 All students under the age of 18 must have consent from a parent/guardian prior to enrollment at a Maricopa Community college in credit, clock, or non credit courses as proof of financial responsibility and for text messaging and automated communication. Please be advised: Consent is valid until rescinded by the parent/legal guardian or until the student turns 18 years of age. Students will be required to comply with additional requirements for admission if they have not yet graduated high school or are participating in early college programs (Dual Enrollment, ACE, Hoop of Learning). Parent/Guardian: please review and provide all required information. Student Information Last Name: First Name: Middle Name: College: Student ID: Parent/Guardian Information Financial Responsibility: As the parent/guardian of a minor student, I acknowledge that I have read the Maricopa Tuition and Fees Policy and the Maricopa Refund Policy. I understand that tuition and fees are added to a student account as a result of enrolling in classes. Once registered and enrolled, if not dropped by the 100% refund deadline, I am responsible for all tuition, fees and fines charged to my student s account. Failure to attend class does not absolve me of the financial obligation as described above. Failure to resolve past due balances may result in impact on services, including holds on my student s account restricting future registration and other services; and forwarding of any unpaid past due balances to collection agencies. Parent/Guardian Name: Relation to Student: Mailing Address: City: State: Zip: Email Address: Phone Number: Social Security Number (Optional): *Social security number will be kept confidential I understand that I am responsible for all tuition, fees, and fines that may be incurred related to my minor student s enrollment in the Maricopa Community Colleges. q YES q NO Consent to Text/Call: I give permission to the Maricopa Community Colleges to contact my student via SMS text messaging and automated calls or other methods of communication for official business to the phone number(s) on file in the student s account. q I consent q I do not consent Please note: All students are enrolled in the ALERT notification system in order to receive Emergency Alerts concerning health and safety of people on campuses/sites via text message. Please ensure your student provides their current cell phone number. Student Signature: Date: Parent Signature: Date:
Dual nrollment Student Admission Application Check the box in front of the college or skill center to identify where you plan to attend. Chandler-Gilbert Estrella Mountain GateWay Glendale Mesa Paradise Valley Phoenix Rio Salado Scottsdale South Mountain GateWay - Maricopa Skill Center Estrella Mountain - Southwest Skill Center APPLICANT INFORMATION Student ID# Term of Enrollment: Fall Spring Summer Year Legal Name Last First Middle Date of Birth Social Security Number Sex ** M F Other Your Social Security Number will not be used as your primary student identification number and will be kept confidential. Individuals that wish to gain full access to Maricopa s secure online self-services resources must provide both the Social Security Number and date of birth. Students should be aware that a correct Social Security Number must be on file for reporting information pertaining to potential tax credit, and must be used by applicants for federal and state aid, and Veteran Administration benefits. Information Release - FERPA Do you give permission for the college to release directory information relative to your enrollment (as per the Family Education Rights and Privacy Act of 1974)? Yes No CONTACT INFORMATION Address Apt# City State Zip Telephone Number Home Mobile Email Address Home Other VERIFICATION OF LAWFUL PRESENCE FOR RESIDENCY/TUITION CLASSIFICATION* * These questions are asked for the purpose of determining tuition. Pursuant to A.R.S. 1-502, 15-1802, 15-1802.01, 15-1803, a person who is not lawfully present in the United States is not entitled to classification as an in-state/in-county student. All applicants for resident tuition and/or financial aid must submit documentation of the above status and any additional proof of residency to the admissions/enrollment services staff upon request. Applicants for resident tuition who fail to answer the questions below or to submit supporting documentation as requested are automatically assessed nonresident tuition. Any student who falsifies information used to establish residency for tuition purposes shall be required to pay full tuition and may be subject to dismissal from the college and/or criminal action. Refer to www.maricopa.edu/residency or the college catalog for residency guidelines. US Citizen Permanent Resident: Alien Registration# Refugee or Asylee: Alien Registration# Foreign Non-immigrant with Visa: Country of Citizenship Specify Visa type Alien Registration/I-94 Number None of the Above: Lawful Presence Otherwise Documented: Specify document(s) AZ Department of Motor Vehicle License or AZ Photo ID Number: DEMOGRAPHIC INFORMATION RACE/ETHNICITY* This is a two part question: Do you consider yourself to be Hispanic/Latino? Yes No If yes, which Ethnic Group? If you responded YES to the above and are of more than one race, select from additional ethnic categories below. If you responded NO, please select one or more of the following racial/ethnic categories to describe yourself. If selecting more than one, please indicate which ethnic category you consider as your primary category. You may also include details regarding your ethnic group or Native American tribe if applicable. Category Primary Y/N Ethnic Group/Tribe American Indian/Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White ** Voluntary information used to comply with Federal Reporting and has no effect on admission to the college. This information will not be used for any discriminatory purpose. The Maricopa County Community College District is an EEO/AA institution. Continued on back...
PREVIOUS EDUCATION High School Status (check one box) High School Diploma High School Name State Completion Date GED Certificate Completion Date State Currently Enrolled High School Name State Expected Completion Date Home Taught Expected Completion Date No diploma or GED and under age 18 No diploma or GED and over age 18 Previous College (check highest level completed) Associate Degree Bachelor Degree Master Degree or higher No College or University Some College/University, no degree FIRST GENERATION COLLEGE STUDENT Have either of your parents completed a Bachelor s Degree? Yes No LANGUAGE BACKGROUND What was the first language you spoke as a child? What languages were spoken in your home when you were growing up? What language do you speak most often now? MILITARY Are you a member of the US Armed Forces, a former member of the US Armed Forces, or a dependent of a member of the US Armed Forces? If yes, select all that apply: I am a current member of the US Armed Forces Yes No I am a dependent of a member of the US Armed Forces Yes No I am a former member of the US Armed Forces Yes No VEHICLE EMISSIONS AGREEMENT In accordance with Arizona Statutes 15-1444 and 15-1449, I hereby certify that my vehicle as required by Arizona Revised Statute 49-542 has passed a vehicle emission test. I also understand that false certification of this affidavit constitutes a class 2 misdemeanor in Arizona. If I fail to comply with the above, I understand that I am prohibited from parking on college property and my vehicle is subjected to removal at my expense. I acknowledge the above statement I do not park on campus RESIDENCY Final residency decisions for tuition purposes will be made in accordance with A.R.S. 15-1801 and regulations of the Maricopa Community College Governing Board. Will you reside in Arizona at the time of attendance? Yes No What date did your present stay in Arizona begin? Month Day Year In what Arizona county do you reside? If Maricopa, what date did you move to this county? Month Day Year What Arizona county did you reside in prior to moving to Maricopa County? Are you seeking admission under special Admissions Programs (Western Undergraduate Exchange or Rio Military)? Yes No If yes, in which state do you currently reside? EDUCATIONAL PLAN Select a primary reason for attending this college: Earn a degree/certificate to enter or advance in the job market Earn a degree/certificate for transfer to another college or university Current university student taking courses to meet university requirements Take courses to transfer (do not intend to earn a degree/certificate) Take courses for job skills (do not intend to earn a degree/certificate) Current High School Student Taking Courses (dual or concurrent enrollment) Personal Interest ACADEMIC LOAD What is your anticipated enrollment: 0-5 Credits (Less than 1/2 Time) 9-11 Credits (3/4 Time) 6-8 Credits (Half-Time) 12 or more Credits (Full-Time) ACADEMIC PLAN What academic plan do you intend to earn from this college? Degree Name: Code: Certificate Name: Code: I CERTIFY THAT THE ANSWERS ON THIS APPLICATION ARE TRUE, CORRECT AND COMPLETE. Signature of Student Date ALL OF THE INFORMATION ON THIS FORM IS CONFIDENTIAL AND IN COMPLIANCE WITH THE FAMILY EDUCATION RIGHTS AND PRIVACY ACT OF 1974. THE ACT S PROVISIONS ARE EXPLAINED IN THE GENERAL CATALOG. For crime statistics reported under the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, please visit www.maricopa.edu/safety revised 02/2016
PARADISE VALLEY COMMUNITY COLLEGE Foothills Academy CP DUAL ENROLLMENT REGISTRATION FORM College Student id# 3 Expected Graduation Date Last First Middle Address City State Zip Date of Birth / / Phone Number ( ) Email Name of High School High School SAIS# Provided by HS To BE COMPLETED BY THE STUDENT: I certify that the information on this enrollment form is true and complete and I give permission to release any and all Paradise Valley Community College information to my parents and/or legal guardian as well as the high school I am currently attending. Student Signature: Date: TO BE COMPLETED BY THE PARENT OR GUARDIAN: As parent or legal guardian, I give my permission for the above named student to enroll in the courses listed, and I accept financial responsibility for tuition and fees. I understand that he/she will be establishing a college academic record and will be required to report such enrollment to future colleges or universities. Parent Signature: Date: Register By Proxy - A student, who is unable to register in person, may have another person register "By Proxy". To comply with federal laws dealing with confidentiality of official student records (Family Right and Privacy Act of 1974). Proxy Agent must provide Photo ID & any necessary documents verifying course pre-requisites. PROOF OF CITIZENSHIP/ RESIDENCY 1. To qualify for in-state tuition, students must provide proof of lawful presence in the United States. Acceptable documents include a copy of your Arizona driver s license/permit, state ID card, US passport, or birth certificate. See maricopa.edu/residency for a complete list of documents. (Only color copies are accepted). 2. If a birth certificate is provided to establish lawful presence (and not a photo ID), students must also provide a copy of their high school photo ID (Only color copies are accepted). IMPORTANT: According to Arizona law, students who are not citizens or legal residents, or who do not submit residency documents, will be charged out-of-state tuition. Select Course on Reverse Side Foothills Academy HS Official use Only SIF ID Enrolled 8/14/17
PARADISE VALLEY COMMUNITY COLLEGE DUAL ENROLLMENT REGISTRATION FORM Foothills Academy CP Course Selection Select class Term HS Period Course Prefix Class Number Instructor Credits Cost Depending on Residency Status Fall 2017 Period 4 10:25 11:15 ENG101 39687 Samantha Gebel 3 $273 Fall 2017 Period 5 11:20-12:10 ENG101 39688 Samantha Gebel 3 $273 Fall 2017 Period 1 7:55-8:45 ENH111 40016 Jonathan Brechner 3 $273 Fall 2017 Period 2 8:50-9:40 ENH111 40017 Jonathan Brechner 3 $273 Fall 2017 Period 1 7:55-8:45 HIS103 19900 Hannah Rude 3 $273 Fall 2017 Period 2 8:50-9:40 HIS103 19899 Hannah Rude 3 $273 Fall 2017 Period 4 10:25-11:15 MAT151 19901 Claudia Moreira 4 $359 Fall 2017 Period 7 1:35-2:230 ART 111 40019 Allison Echanove 3 $273 *Spring course enrollment will occur in January 2017 Year long Period 5 11:20-12:10 BIO100 19902/19903 Aymen Hariz 4 $359 *Enrollment for Fall is for the entire academic year (Fall 16 & Spring 17) Foothills Academy HS Official use Only SIF ID Enrolled 8/14/17