Fletcher Dual Enrollment Student Application

Please complete the high school dual enrollment application below.

Together we will work with you and your high school to ensure you are enrolling into courses to enhance your academic skills, explore future career and college pathways all while earning college credit early. By completing this application you are consenting that Fletcher Technical Community College enrolls you into courses.

Name

First NameMiddle NameLast Name

Date of Birth

Date

Student Email

example@example.com

Parent Email for Parental Consent Form

example@example.com

Student Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Which term are you completing this application for?

Student Grade Level

Student High School is Attending

Are you enrolling at a satellite campus?

If Yes, select one:

Please check off on each statement:

I understand that it is the students responsibility to OFFICIALLY WITHDRAW or DROP a class that they decide not to complete by Fletcher's published deadline. If they withdraw they may not be eligible for Dual Enrollment participation next semester. In addition, I understand that withdrawing or not completing courses(s), may affect any future financial aid (Pell Grants, TOPS, TOPS Tech, etc.) that the student is eligible to receive after graduation from high school.By signing this form, I hereby acknowledge that I understand that Fletcher Technical Community College students become obligated to pay all tuition, fee, and associated charges at the time of registration. Failure to do so will result in further action to collect the balance due. This may include the transfer of the balance due to the State of Louisiana Office of the Attorney General for collection. An individual with a transferred account is responsible for all collection charges including, but not limited to, attorney and court costs

Parent Name

First NameLast Name

Parent Signature

Parental Signature Date

Date

Do you recommend the student listed above for Dual Enrollment?

If Yes, please upload Test Scores and Signature Sheet

What course(s) will this student be enrolling into?

Counselor Signature

Fletcher Dual Enrollment Student Application

Student Information

Parental Consent

High School Counselor Recommendation