Concurrent Enrollment Application Packet

Office of Admissions & Records

1507 So McKenna

Poteau, OK 74953

918-647-1300 voice  918-647-1306 fax 

www.carlalbert.edu



Sallisaw Campus, 1601 Opdyke, Sallisaw, OK 74955  918-775-6977 

Carl Albert State College

Concurrent Enrollment

Application

Attach:

New students submit the following documents for first-time

admissions to CASC and initial enrollment.

These documents are submitted at time of first-admissions

for concurrent enrollment.

 Permissions Form

 Application for Admissions

 NATIONAL ACT test scores

 High School transcript

 High School COURSE SCHEDULE (for upcoming term)

 Provide social security card or evidence to confirm SSN

 Provide drivers license or other ID to confirm identity

Please know that students must submit their high school course schedule

each semester of concurrent enrollment, so that the Office of Admissions may

verify the student is enrolling in no more than a combined 19 credit hours of high

school and college coursework. Students may file a Petition of Overload with the

Office of Admission for approval or denial of overload situations.

Deliver to:

By Mail:

By Fax:

In-Person:

Carl Albert State College

918-647-1306

Poteau Campus, Hemphill Hall

Office of Admissions

Sallisaw Campus

1507 So McKenna

Poteau, OK 74953

Concurrent Enrollment

Guidelines

C A R L A L B E R T S T A T E C O L L E G E

Office of Admissions 1507 So McKenna  Poteau, OK 74953  918-647-1300 voice  918-647-1306 fax

ADMISSIONS REQUIREMENTS FOR NEW CONCURRENT STUDENTS TO CARL ALBERT STATE COLLEGE

In accordance to the Oklahoma State Regents for Higher Education, a senior or junior high school student who is enrolled in an accredited high school may be admitted to CASC if he/she meets the requirements set forth below:

Seniors: 3.0 GPA or 19 ACT score or higher Juniors: 3.5 GPA or 21 ACT score or higher

Students receiving instruction at home (Home Schooled) or from an unaccredited high school are considered a senior at age 17 and a junior at age 16 (based upon summer entry term and when high school peer class will graduate). GED recipients remain under concurrent enrollment policy until their high school class has graduated. Admissions requirements and course eligibility apply as stated. DOCUMENTS NEW CONCURRENT STUDENTS MUST SUBMIT

1) Application for Admissions

2) Immunization Compliance Waiver Form 3) NATIONAL ACT Test scores

4) Official high school transcript

5) Permissions Form for First-time Entering Students 6) High School Course Schedule for term of enrollment 7) Copy of Social Security Card and

8) Copy of Driver’s License COURSE ELIGIBILITY

Concurrent students must obtain a 19 or higher on their ACT subject test score in English 1113, mathematics, and science to enroll into courses in those respective subject areas. A 19 or higher Reading ACT subject test must be scored to enroll in any other collegiate course (outside the subjects of English, mathematics, and science).

 Concurrent students may not enroll in zero-level courses.

 Concurrent students may not take a COMPASS exam to remove any deficiency

 Concurrent students may enroll in 9 semester hours in the summer term without also being enrolled in high school.

 Students may enroll in a combined number of high school and college courses of 19 semester credit hours. All graded ½ unit high school classes are valued to 3 credit hours. To remain enrolled, the Office of Admissions will confirm that this 19 cr-hr limit is met by examining the high school and college course schedules.

 Students must submit a course schedule from their high school each semester of concurrent enrollment (summer, fall, spring). If course schedule is not submitted to the Office of Admissions before classes begin, then, the student will be Withdrawn from all CASC classes.

 Students enrolled in more than a combined 19 credit hours must submit a Petition for Overload to the Office of Admissions and if approved may enroll in or remain enrolled in 19 or more hours. If Petition is not submitted before classes begin, then, student will be Withdrawn from CASC classes.

 Concurrent students may continue enrollment in subsequent semesters with a cumulative college 2.0 GPA.

 Students whose GPA falls below 2.00 will be immediately suspended from CASC, ineligible to enroll under concurrent enrollment, and must wait until after their high school graduation to enroll in college.

 Students may enroll into accelerated courses when their high school is not in session.

 Students can view their final grades on-line through their VIKECONNECT account. Grades are not postal mailed.

 With signature on the Permissions Form, students give the Office of Admissions permission to mail an official transcript to the high school and to visit with the high school counselor/school official on their behalf.

TUITION WAIVER & FEES

SENIORS who are Oklahoma Residents and attending an Oklahoma high school and are eligible for a Tuition Waiver that waives only tuition charges, and for a maximum of 6 hours per semester. Students are responsible for fees, books, and other education expenses. Student accounts balance must be paid to re-enroll. (Billing questions call Poteau 918-647-1325 or Sallisaw 918-775-6977). PARENTS AND RELEASE OF INFORMATION

: FERPA

In accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974, CASC must obtain written consent before releasing a student’s records to a “third party.” Parents included. However, the Office of Admissions has male available the Permission to Release

Student Records form in their office or online (see Admissions>Student Forms) that gives parent(s) permission to obtain information,

transcripts, course schedules, and other documents on their student. RETURNING CONCURRENT STUDENTS

Returning students must submit: 1) Permissions Form for Returning Concurrent Enrollment Students, 2) course schedule for term of concurrent enrollment, 3) any National ACT test scores that updates/supports enrollment, and have a minimum 2.00 college GPA and a zero balance with CASC Business Office. (Billing questions call Poteau 918-647-1325 or Sallisaw 918-775-6977). VIKECONNECT

Students must establish their VIKECONNECT account and obtain Username & Password to access BLACKBOARD & Student email.

Permissions Form

For First-Time High School Concurrent Enrollment

C A R L A L B E R T S T A T E C O L L E G E

Office of Admissions 1507 So McKenna  Poteau, OK 74953  918-647-1300 voice  918-647-1306 fax

Please know that: (see attached Guidelines for more details)

1. Tuition waivers are given to seniors who are Oklahoma residents and attend an Oklahoma high school, and for up to 6 hours per semester. (Student remains liable for fees, books, and hours taken above 6.)

2. Accelerated courses may be taken only when the high school is not in session.

3. With their signature below, students give the Admissions Office permission to mail their official CASC transcript to their high school and visit with school officials concerning their enrollment or progress.

4. Students must submit their high school course schedule before classes begin or will be Administratively Withdrawn from all college classes. Students judged to have over 19 combined cr-hrs will be Administratively Withdrawn or given the opportunity to file a Petition for Overload with the Office of Admissions.

                                 

 Cumulative college GPA :__________ (If less than 2.00, then student is ineligible and may not enroll as HS Concurrent).  Student Full Name:_________________________________ High School:________________________________  Social Security Number:__________________________ CASC ID#:__________________________________  Semester (check one): Summer Fall Spring Year (write-in): 20________ Class (check one): Senior Junior

 If we have questions, please tell us your email and/or cell#:_______________________________________________

Student Signature: _________________________________________ Date:__________________ P L E A S E W R I T E - I N T H O S E C O U R S E S Y O U W I S H T O E N R O L L :

COURSE NUMBER SECTION # COURSE DESCRIPTION DAY/TIME INSTRUCTOR

1) 2)

High School Principal Certification and Permission

As high school principal, I have examined the academic record for this student and certify that he/she is eligbile to satisfy high school gradution requirements no later than the last semester of their senior year.

Principal Name (please print):______________________________ Signature: _________________________ Date:__________________

High School Counselor Certification and Permission

As high school counselor, I certify that he/she is eligible for concurrent enrollment at CASC and judge them to be

academically ready for college-level courses. I certify that this student meets the ACT subject test eligibility requirements to enroll in the above classes. I will work with CASC to verify the student is enrolled in 19 or fewer combined hours or help any eligible student file the Petition for Overload when 19 or more combined hours are requested.

Counselor Name (please print):______________________________ Signature: _________________________ Date:__________________

Parent/Guardian Permission

As parent or legal guardian, I give by permission for this student to enroll concurrently with the high school and Carl Albert State College in the courses and semester listed above.

Parent/Guardian Name (please print):______________________________ Signature: _________________________ Date:______________

Application for Admissions

Modified for High School Conc urrent Enrollment Students

Office of Admissions  1507 S McKenna  Poteau, OK 74953  918-647-1300 voice  918-647-1306 fax

C a r l A l b e r t S t a t e C o l l e g e

Office of Admissions  1507 So McKenna  Poteau, OK 74953

918-647-1306 fax  918-647-1300 voice  www.carlalbert.edu >CASC PORTAL>Admissions

Instructions: This Application is modified for Concurrent Enrollment Students. -- Students must submit the 1) Concurrent Enrollment form, 2) Applications for Admissions, and credentials for full enrollment (high school transcript, ACT test scores, high school COURSE SCHEDULE). Students are asked to print clearly; answer all items listed; read, understand, and sign the signature page. Application and credentials may be submitted in person to the Office of Admissions at the Poteau or Sallisaw campuses, by mail or fax to the address above.

Entry Information

Campus

 Poteau  Sallisaw  Web

Entry Classification

 High School Concurrent

Are you seeking a degree with CASC?

 No, I am enrolling as a Concurrent High School or

Non-Degree Seeking/Special student

Term

 Summer 20____  Fall 20____  Spring 20____

Applicant Information

Social Security Number

-

-

Birth Date

/ /

What is your Age?

Legal Name

Last First Middle Suffix

Previous Names

Address

City

State

Zip

County

Home Phone

Cell Phone

Email

Sex

 Male  Female

Marital Status

 Single  Married  Divorced  Separated

Emergency Contact

Full Name Phone

General Information

Ethnicity/Race

This information is voluntary and is used for state & federal reporting. This information does not affect your admissions to CASC.

 Not Hispanic/Latino

 Hispanic/Latino

 American Indian/Alaskan Native

(check all that apply

)

Tribe: _____________________ Lineage:  Father  Mother  Both  Unknown

 Asian  Black/African American  Native Hawaiian/Pacific Islander  White

Family Education Background

Has your Mother earned at least a Bachelor’s degree?  Yes  No

Has your Father earned at least a Bachelor’s degree?  Yes  No

Are you the first member of your family to attend college?  Yes  No

A

P P L I CA T I O N FO R

A

D M I S SI ON S O F F I C EO FA D M I S S I O N S

MO D I F I E D F O R HI G H SC H O O L CO N C U R R E N T EN R O L L M E N T

Office of Admissions  1507 S McKenna  Poteau, OK 74953  918-647-1300 voice  918-647-1306 fax

ID:

Application for Admissions

Modified for High School Conc urrent Enrollment Students

918-647-

-647-Residency & Citizenship

Are you a US citizen?  US Citizen  Legal Permanent Resident  Undocumented Resident

If not, what is your country of citizenship? _____________________________________________________

Are you a resident of Oklahoma?  Yes  No How long? ____years ____ months -or- ______Lifetime

If not, list state of residency? _______________________ How long? ____years ____ months

An Oklahoma Resident is one who has lived continuously in Oklahoma for the last 12 months for reasons other than education and whose domicile is Oklahoma. (Change of residency questions should be directed to the Office of Admissions.)

Educational Background

Office Use

_{ High School}

 Home School

Name of High School City/State

Anticipated Graduation

(mo/year)

Have you taken?  ACT  SAT

(National ACT Test only)

Have you previously attended any Oklahoma vocational school?  Yes  No

Have you previously attended any other college or university?  Yes  No

(If yes, an official transcript is required from all colleges previously attended and prior to successful admissions and enrollment)

Codes _{List all Colleges previously attended City/State Dates Attended Hours Earned}

Disclosure Requirement

1. Have you ever been convicted of a felony?  Yes  No

2. Have you ever been placed on disciplinary probation or suspension from a college or university?  Yes  No

If you answer Yes to either question, please attach a written statement of disclosure (plain sheet of paper, dated, and signed).

Signatures

Student PRINT Name Student Signature Date

Parent/Legal Guardian PRINT Name Parent/Legal Guardian Signature Date

In compliance with Titles VI and VII of the Civil Rights Acts of 1964, amended, Title IX of the Education Amendments of 1972, American Disabilities Act of 1990, and other federal laws and regulations, does not discriminate on the basis of race, color, national origin, sex, age, religion, disability, or status as a veteran in any of its policies, practices, or procedures. This includes but is not limited to admissions, employment, financial aid, and educational services. Please contact our ADA Coordinator at 918-647-1389 if you have any questions regarding services for students with disabilities.

Read & Sign

A

P P L I CA T I O N FO R

A

D M I S SI ON S O F F I C EO FA D M I S S I O N S

MO D I F I E D F O R HI G H SC H O O L CO N C U R R E N T EN R O L L M E N T

Office of Admissions  1507 S McKenna  Poteau, OK 74953  918-647-1300 voice  918-647-1306 fax

ID:

Immunization Compliance Form

Immunization Policy: Exemption Statement

for Students with Exemptions or Exceptions

In Compliance with Oklahoma Statutes, Title 70 §3242

Instructions:

Students who successfully complete and sign this form do not have to provide the Office of Admissions with Immunization Records. - - State law allows for certain exemptions based upon medical contraindications, religious or moral objections. The Board of Regents, in its discretion, includes exceptions to the requirement for vaccinations for each of the following categories of students. Additionally, the immunization requirement shall not apply to students enrolling in courses delivered through the Internet or at distance learning sites which the student is not required to attend class on campus.



Check Exemption below:



concurrently enrolled high school student;



graduated from a high school in a state that requires vaccinations for hepatitis B, measles, mumps, and rubella;



transferring from an institution within The Oklahoma State System of Higher Education or private institution of higher learning located within this state and accredited pursuant to Section 4103 of Title 70 of the Oklahoma Statutes;



born before January 1, 1956;



a member of a National Guard Unit or Military Reserve Unit or who is currently on active duty in a branch of the United States military, or



enrolling only in web-based courses or at a distance learning site.



Religious Objections: (summarize:_______________________________________________________________

_____________________________________________________________________________________________)



Moral or Personal Objection: (summarize:________________________________________________________

_____________________________________________________________________________________________)



Medical Contraindications (to be completed by Physician:____________________________________________

_____________________________________________________________________________________________

Physician Signature Date



Student Signature Required:

Student PRINT Name Student Signature Date

List High School:

Additional information on immunizations may be found at:

Center for Disease Control www.cdc.gov