Southeastern Community College

Application For Concurrent Enrollment

 

This application is for high school students who plan to enroll in a college credit class while still in high school. Credit and grade earned will be reported on your permanent college transcript. Course grades and completion of classes will be calculated towards your Satisfactory Academic Progress. Please check with your high school counselor if the credit and grade will be reported/calculated on your high school transcript.

To request accommodations, please contact the Disability Services office at 319-208-5167 or visit our Disability Services page. PLEASE NOTE: Because this is a college level credit-bearing class you cannot utilize your IEP or 504 plan for this class. You will need to utilize accommodations that are assigned through the Southeastern Community College Disability Services Office.

If you are considering attending SCC after high school please complete our regular Application for Admission (not the concurrent enrollment application) which is available online at www.scciowa.edu or in Enrollment Services, submit placement tests (if you have not done so already) and complete new student orientation.

Thank you for your interest in SCC - we look forward to working with you.

 

* denotes optional information.

First Name:

Middle Name: If no legal middle name, please enter 'x'

Last Name:

Social Security Number:

* E-mail Address:

* Confirm E-Mail Address:

* Prior Legal Last Name:

Birth Date: in MMDDYYYY format

Ethnicity and gender information requested is used only to comply with federal reporting and has no effect on admission to the college or for any discriminatory purposes.

* Gender Identity:

* Personal Pronoun:

* Ethnicity:

*Are you a United States citizen?   Yes   No
  If NO, are you a permanent resident of the United States?   Yes   No

* Which race are you? (select one or more)
     American/Alaska Native
     Asian
     Asian/Pacific Islander
     Black or African American
     Hawaiian/Pacific Islander
     White

Permanent Address

P.O. Box: if applicable

Full Street Address: if applicable

City:

State:

Zip Code:

Current Address - Enter only if different from permanent address

* P.O. Box:

* Full Street Address:

* City:

* State:

* Zip Code:

Phone Numbers

Phone Number: Please include your area code.

* Secondary Phone Number: Please include your area code.

Enrollment Interest

When will this class(es) be offered:

Where will your class(es) be offered (check all that apply)

     SCC Location   High School   Online

Admissions Information

Do you plan to seek a college degree or diploma from any institution?

Do either of your parents/guardians have a four-year degree?:

Are you considering attending SCC after High School?

     If YES, semester you plan to enter SCC:

NOTE - Programs may contain the following designations in the description: * = Keokuk Campus offers Selected Courses, K = Keokuk Campus, KE = Keokuk Evening, OL = Online, WB = West Burlington Campus, WBE = West Burlington Evening

    SCC Program You Plan To Enter After High School:
   

     If NO, where do you plan to attend?

     Program you plan to enter after High School at another college:
     

College Educational Goals:


High School Anticipated Graduation Year:

High School City:

High School State:

Institution Name:

    --OR--

Enter Institution Name:
 (if not listed above)

By clicking "Submit Application", I certify that, to the best of my knowledge, the above information is true and complete. I also agree to abide by all approved policies as outlined in the current issue of the college catalog. I will report all changes, including name and address, to the SCC Enrollment Office. I understand that my admission may be delayed if all changes are not reported. I give my permission to allow SCC to communicate with me by electronic means to inform me of college updates, alerts, and other college-related news. I also understand that I may be photographed at various college events and activities held in public areas throughout the college and that such a photograph may be used in college publications, websites and other marketing materials. In giving this consent, I release Southeastern Community College, their agents, and assigns from any liability for any violation of personal property rights which I might have in connection with such materials and waive any right to approve accompanying written or narrative material.

Clery Act. Southeastern Community College is committed to providing the safest environment possible for work and study. Part of this commitment involves providing information about campus security to current and prospective students as well as employees. A report, prepared in compliance with the Crime Awareness and Campus Security Act of 1990 (Clery Act), outlines the college's security policies and discloses campus crime statistics. For a copy of this document, contact: Student Services, Southeastern Community College, P.O. Box 180, 1500 West Agency Road, West Burlington, IA 52655-0180. Southeastern Community College provides equal educational and employment opportunities and does not illegally discriminate on the basis of gender, race, national origin, age, marital status, or disability in its educational programs, activities, or employment and personnel practices.

It is the policy of Southeastern Community College to select, develop, and promote employees and students based on individual ability and performance. It has been, and shall continue to be, the policy of Southeastern Community College not to discriminate on the basis of race, creed, color, sexual orientation, gender identity, national origin, sex, disability, religion, or age in its programs, activities, or employment practices as required by the Iowa Code sections 216.9 and 256.10(2), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. 1681 - 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. 794), and the Americans with Disabilities Act (42 U.S.C. 12101, et seq.). Individuals having questions or complaints related to compliance with this policy should contact Human Resources, Southeastern Community College, 1500 W. Agency Road, West Burlington, IA 52655, phone number 319/208-5063, fax 319/208-5006 or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312/730-1560, fax 312/730-1576.

SCC West Burlington CampusSCC Keokuk Campus
Enrollment Services OfficeEnrollment Services Office
P.O. Box 180 
1500 West Agency Road339 Messenger Road
West Burlington, IA 52655-0180Keokuk, IA 52632-6007

 

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