Concurrent Enrollment Application

Person Ref

ELIGIBILITY REQUIREMENTS FOR CONCURRENT ENROLLEMENT

Enrolled students must be entering their senior year in high school.
Have a cumulative grade point average of 80 or higher.
Recommended by the school principal, teacher, or school counselor.
Enrolled students must meet the course prerequisite requirements as stated in the College Catalog. ** Requests for enrollment exceptions can be made by the school counselor to the Assistant Vice President for Academic/Student Services and are considered on a case-by-case basis.

Personal Information

Legal First Name

Legal Last Name

Preferred Name (only if different from Legal First Name listed above)

Social Security Number

Enter your United States of America SSN. This number is confidential and, under federal law, it is protected and will not be disclosed to unauthorized parties. Disclosures may be authorized for the purposes of state and federal financial aid, Hope Lifetime Learning tax credits, institutional assessment, academic transcripts, or accountability research.

Legal Sex

Female

Male

Gender Identity

Female

Male

Non-Binary

Preferred Pronoun

He/Him

Other

She/Her

They/Them

Birthdate

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests.

Primary Citizenship

Residency Status

Legal permanent resudent

I am a non-citizen

Please upload a photo/copy of your legal permanent residency card.

Race (optional)
Check all that apply

Are you Hispanic or Latino?

Yes

No

Hispanic/Latino background

Contact Information

Permanent Address (please include apartment numbers in the street section)

Example Street Address:

123 Example Street, Apt 45

Country

Street

City

Region

Postal Code

Has New York State been your legal residence for the past year?

Yes

No

Have you lived in Nassau County for the las six months?

Yes

No

Mobile Phone Number

Personal Email Address (school email addresses are not acceptable)

High School Information

High School Name

CEEB code

Level of Study

Anticipated Graduation Year

High School Counselor's First Name

High School Counselor's Last Name

High School Counselor's Email Address

Please upload your official High School transcript.

Parent/Legal Guardian Information

Relationship

Mother

Father

Legal Guardian

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Cell Phone Number

Academic Information

Have you previously applied or taken a course at NCC?

Yes

No

Have you attended a New York high school for at least 2 years?

Yes

No

Select the anticipated semester.

Fall 2024

Signature

Check the box acknowledging submission of this form will serve as an electronic signature

I declare that all statements made in this application are, to the best of my knowledge, true and correct. I understand that if I was born on or after January 1, 1957 and if I enroll for 6 or more chargeable credits, I must provide the College with proof of immunization against measles, mumps, and rubella. ALL students regardless of age who are enrolled for six or more credit hours must fill out the meningitis survey which is available through the Health Center. My failure to comply with this New York Sate law within 30 days from the start of the semester will result in my disenrollment from classes without refund of tuition and fees.

Students with overdue tuition and fees may be referred to a collection agency and will incur additional liabilities of up to 33% to cover all associated collection costs processes. Further, I understand that the College may have such default information forwarded to credit reporting agencies.

By providing your mobile number you are giving permission to the college to send you text message notifications.

Student Signature (please type your full legal name)

Check the box acknowledging submission of this form will serve as an electronic signature.

As the parent or guardian of the NCC Concurrent Enrollment student, I understood and agreed with the requirements, limitations, and procedures of the Nassau Community College Concurrent Enrollment Program. I also understand and agree with the creation of a permanent academic history and transcript at NCC for my child, the release of my child’s transcript to the high school until my child’s graduation, and the right of the college to notify me if my child becomes involved in any incident requiring disciplinary action. I also understand that some courses may deal with adult content subject matter. Furthermore, I accept full responsibility for all tuition and fees that result from my child’s registration in courses through the NCC Concurrent Enrollment Program.

By providing your mobile number you are permitting the college to send you text message notifications.

Parent Signature (please type parent full name)