Application For Admission Form
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1
2Career and College Promise Program Form
Year Enter ______
Beaufort County
Fall
Community College
Spring
Summer
Age of Student___________
Projected Graduation Date: Month____________Year__________(Date Required)
-
-
SOCIAL SECURITY NUMBER
LAST NAME (SR. II. ETC.)
FIRST NAME
MIDDLE NAME
OTHER NAMES
-
AREA CODE
HOME NUMBER
STREET NUMBER AND NAME
APT NO
ROUTE NO
BOX NO
CITY
STATE
ZIP
COUNTY
-
-
MONTH
DATE
YEAR
BIRTHDAY
Pathway Options
Please indicate the Pathway you will follow____________________________________________________
I give my permission for the personnel at Beaufort County Community College to release information regarding my attendance,
academic progress, test scores, and final transcript to the high school listed below. This release will remain in effect until such time as I
rescind it in writing.
Student’s Signature ____________________________________________Date___________________________
NOTICE TO STUDENTS: Students will be required to take a Computerized Placement Test (CPT) prior to enrollment.
As Principal of __________________________________High School, I do hereby give my permission for the above student to enroll at
Beaufort County Community College. I do certify that this student, while enrolled at the College, is also enrolled at the high school and
is making appropriate progress toward high school graduation.
___________________________________________________________________________________________
Principal’s Signature
Date
FOR COLLEGE USE ONLY
___________________________________________________________________________________________
Director of High School Programs
Date
Your Social Security number is used for informational purposes only.
Please note: Fall Term high school graduates are
not
eligible to participate in the Program for Spring Semester.
Spring Term high school graduates are
not
eligible to participate in the Program for Summer Term.
An Equal Opportunity Institution
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