SANTA FE COLLEGE HIGH SCHOOL DUAL ENROLLMENT PROGRAM APPLICATION

OFFICE USE ONLY

SFC ID: Program #:

Program:

Sent CPT: Acceptance Date:

DIRECTIONS: Please submit this application to the High School Dual Enrollment Office. If you have ACT or SAT scores, please attach a copy of your official scores.
Notification of Collection and Use of Social Security Numbers (Section 119.071(5), Florida Statutes) This notice is intended for students, employees, and applicants. Santa Fe College collects your social security number for use in performance of the Colleges duties and responsibilities for the following possible purposes: classification of accounts; identification and verification; credit worthiness; billing and payments; data collection; reconciliation; tracking; benefit processing; tax and scholarship reporting; financial aid processing; athletics recruiting; accreditation of programs; and reporting to authorized agencies of the state and federal government. Social security numbers are also used as a unique numeric identifier in certain cases and may be used for search purposes. Federal Law requires that we protect social security numbers from disclosure to unauthorized parties. Students and employees are assigned SFC identification numbers to assist in protecting their identities.

Name: Last: Address: City:

Social Security Number: Student Home Phone:

First: State:

Middle: Apt/Lot #: Zip Code:

(Social Security number needed to create your SFC ID number)

Student CELL: County: Country of Citizenship: Date of Birth: Current High School: Is this a zoning exemption? Yes No Bright Futures Scholarship Candidate: Yes No Current Grade Level: Expected Graduation Date:
Select a Dual Enrollment option: College Academic (AA) College Fine Arts College Technology & Applied Sciences Are you presently employed? Yes No Hours per week: Employed by: ESE and 504 students, must attach an accommodation plan, psychological evaluation or 504 eligibility documentation. This must be obtained from your school. Please check ESE 504 Home school students must complete paper work if they wish to enroll in name only at a public school to be able to receive free textbooks and qualifying meal program.

Private school students must submit a transcript with this application. If you have a zoning exemption, you will need to complete an exemption form every year.
For statistical purposes only: Gender: Male Female Race: 1. White, Non-Hispanic 2. Black, Non-Hispanic 3. American Indian 4. Asian or Pacific Islander 5. Hispanic 6. Other

Father/Guardian: Last:

First: Apt/Lot#: State: Employer: Work Phone: First: Apt/Lot#: State: Employer: Work Phone:

Middle: Zip Code:

Address: City: Home Phone: Cell Phone: Email:

Mother/Guardian: Last:

Middle: Zip Code:

Address: City: Home Phone: Cell Phone: Email:

Emergency: Local person other than parent/guardian: Name: Home Phone: Cell Phone:

Work Phone:

My signature gives permission to share my educational records with my instructors, counselor and parent(s)/guardian(s) to ensure success. I understand that the grades I receive in college courses will remain on my permanent college transcript.

Signature of Applicant:

Date:

I understand that Dual Enrollment students interact with college students and are exposed to the social and intellectual challenges of a college campus. Signature of Parent or Guardian: Date: Applicant is considered a dependent for your tax purposes? Yes No

On the reverse side of this application please explain your reason(s) for applying. State your career goals, interests and experiences that will help us in reviewing your application.

Please write an essay describing your career goals, interests and experiences. Your essay will help us select an appropriate Dual Enrollment Program for you. (use a separate page if necessary)