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Dual Enrollment at HACCEnrollment ProcessComplete the Application for Admission: College Programs for High School StudentsApplications are available at your high school counseling office or directly from your HACC AdmissionsCounselor*.(Note: Application requires student, parent/guardian, and school counselor/principal signature to be processed.)High School TranscriptsSubmit a copy of your high school transcript with your application.(Note: Application must include a copy of your high school transcript in order to be processed.)SAT and ACT Scores (if applicable for student)If you have taken the SAT or ACT, include a copy of the score report with your application.(Note: Scores may be used to determine possible exemption from HACC’s placement testing.)TESTSAT/ACT ReadingSAT/ACT WritingSAT/ACT MathSCORE480 or above/18 or higher480 or above/21 or higher550 or above/23 or higherEXEMPTIONReading Placement TestWriting Placement TestMath Placement TestSubmit a copy of your class registration formRegistration forms are available at your high school counseling office, or directly from your HACC AdmissionsCounselor*.(Note: If you know the classes in which you’d like to enroll, submit this form along with your application. Ifnot, you may submit the registration form after placement testing is completed.)Confirmation EmailAfter the application has been processed, a confirmation email will be sent to the email address you providedon your application, followed by a second email with your “myhacc” log-in information.Placement Testingvisit www.hacc.edu/placementYour admissions counselor* will notify you via email if placement testing is required.If placement testing is required, bring a photo ID to HACC’s Lancaster Campus during the following days andtimes (no appointment is necessary):Mondays and Fridays, between 9AM and 2PMTuesdays, Wednesdays, and Thursdays, between 9AM and 6PMEnter the Main building, sign-in at the Welcome Center, and staff will direct you to the Testing Center.Then contact your admissions counselor* when you have completed the testing and enroll in theappropriate class(es).Attend New Student OrientationLearn about HACC technology and academic resources.Pay Tuition and FeesPay tuition and fees before the due date, either in person at HACC’s Welcome Center, by calling theWelcome Center at 717-358-2966, or online using your myhacc account.*YOUR HACC Admissions Counselor:Marcia Waters(717) 358-2997mswaters@hacc.eduRevised 02/13/2019

Application for AdmissionCollege Programs for High School StudentsFinallyApplyNow!Complete if you are a first-time applicant wishing to participate incollege programs for high school students.Submit this application for admission to your school counselor/representative or to Admissions at the HACC campus nearest to you.If you have any questions, please call 800-ABC-HACC.

Application for AdmissionCollege Programs for High School StudentsOFFICE USE ONLYHACC ID:Admit Type:Program:Date Received:Term:Contact Information (please print)Last Name First Name MIMailing AddressCity State Zip CountyPrimary Phone Number ( ) –Mobile Phone Number ( ) –Email AddressParent/Guardian 1 Parent/Guardian 1 EmailParent/Guardian 2 Parent/Guardian 2 EmailResidencyIndicate in which school district and state you reside. You are considered a Pennsylvania resident only if you have lived in the state for one full year.You must alert HACC if your residency changes.School District of ResidenceState of Permanent ResidenceNote: Students currently residing in one of HACC’s 22 sponsoring school districts located in Cumberland, Dauphin or Perry Counties must submit a valid Certificate of Residence from theirschool district office before they qualify to receive the sponsored tuition rate. Sponsoring school district subsidy does not apply to College in the High School/Technical School courses.How long have you resided in the state of Pennsylvania? Years(s) Month(s)Personal InformationThis information is used for statistical purposes and will not be used to determine admission.Social Security Number* or HACCID: Gender: M FDate of Birth: / / (mm/dd/yyyy)*(Note: Providing your social security number is voluntary. If you provide it, the college will use your social security number for tax purposes, determining eligibility forfinancial aid and veteran benefits. To protect your privacy, it will not be used as your student identification number.)Are you a United States citizen? Yes No (If no, please supply required information in shaded area below.) No. I am a permanent resident and am submitting a copy of my Permanent Resident card with this application. (Do not check this box if you are a U.S. citizen.) No. I am a non-resident alien, have completed the questions below and am submitting a copy of my current visa and I-94 Card with this application.Country of Citizenship? Current visa?(Note: Students whose primary language is not English may be required to take the HACC ESL placement test.)What is your primary language?Ethnicity (Check one) Hispanic/Latino Non-Hispanic/LatinoRace: (Check one or more) American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Asian White2 Black/African American

High School/Career and Technical School/Home School InformationHigh School/Career and Technical School/Home School Name:Anticipated Graduation Date: / /(mm/dd/yyyy)Are you currently home-schooled? Yes NoDo you currently participate in a Free and Reduced Lunch program? Yes NoDo you plan to attend HACC after graduating from high school? Yes Unsure No, I plan to attendProgram InformationRegistration Year/Term: 20 Spring Fall SummerWhich HACC location do you plan to attend? Gettysburg Harrisburg Lancaster Lebanon YorkDo you intend to take classes in your high school/career and technical school through the College in the High School (CHS) program? Yes NoDo you intend to enroll in an on-campus class? Yes NoDo you intend to take AT LEAST ONE online class? Yes NoDo you intend to ONLY take online classes? Yes NoRelease of Student InformationHigh School/Career and Technical School/Home School- (Required): The Federal Educational Rights to Privacy Act (FERPA) of 1974 requires your writtenconsent to disclose information to your parent(s), your spouse if you are married, or other third party agencies. Without this consent, HACC cannot release yourinformation to a third party. By completing the information below, you agree to share information with your school.I authorize HACC, Central Pennsylvania’s Community College, to disclose written information on all of my past and current college information regarding(check all that apply):ütest dataüacademic records personal information student account informationPrint the name and address of your school:School NameStreet AddressCityStateZipRelease of Information Authorization End Date / / (Anticipated high school graduation date recommended)(mm/dd/yyyy)Third-Party Release (Optional)Release of Student Information: The Federal Educational Rights to Privacy Act (FERPA) of 1974 requires your written consent to disclose information toyour parent(s), your spouse if you are married, or other third party agencies. Without this consent, HACC cannot release your information to a third party.By completing the information below, you agree to share information with your school (required) or another third party.I authorize HACC, Central Pennsylvania’s Community College, to disclose written information on all of my past and current college information regarding(check all that apply): test data academic records personal information student account informationPrint the name and address of any additional individual, parent/guardian or agency to which your information may be disclosed:Parent/Guardian or Other NameStreet AddressCityStateZipRelationship to StudentRelease of Information Authorization End Date / / (Anticipated high school graduation date recommended)(mm/dd/yyyy)3

Student Memorandum of UnderstandingI agree to abide by the policies and regulations of HACC, Central Pennsylvania’s Community College. Further, I understand the following: I am responsible to ensure that all required forms and documentation are submitted in a timely manner and that required placement testing is completed beforecourse enrollment is processed; Admission to HACC and enrollment in Dual Enrollment College Programs for high school students are separate processes and placement testing may determineeligibility for enrollment; I risk being dropped from my classes if I fail to pay tuition in full or fail to make payment arrangements by the due date; I understand that I am enrolling in a college class which may contain content that challenges my perceptions of the world around me and expose me tocontroversial or adult topics; I take full responsibility for the outcome of the courses as outlined in the course syllabus provided by the instructor; and In the event that I decide to discontinue enrollment in any course, I will immediately notify HACC Admissions and my instructor(s).In addition, by signing this document, I, the student, agree to the terms of the Student Memorandum of Understanding and the Authorization to Release InformationStatement.I hereby understand that any misrepresentation of information in this application may result in denial of admission or dismissal.Student Signature(mm/dd/yyyy)Parent/Guardian SignatureI, the parent/guardian, have reviewed this application for the Dual Enrollment Program and approve my dependent child’s financial and educational responsibilitiesto participate with my signature below.Parent/Guardian Signature (required if student is under age 18)(mm/dd/yyyy) Students participating in Free and Reduced Lunch programs may be eligible to receive a tuition reduction. If you DO NOT wish to be considered for thisopportunity, please check this box.High School RecommendationI, the undersigned, have reviewed this application/enrollment form(s) with the student and attest to the school district support of the student participating in theHACC College Programs for High School Students. The student will be a high school junior or senior at the time of registration. I confirm all student information,to be accurate.High School Counselor or Principal /V 2018 170427-24074(mm/dd/yyyy)

Enrollment Form to Register for Credit CoursesCollege Programs for High School StudentsINSTRUCTIONS: Complete a paper enrollment form for each term. Students cannot register online. If a course requires placement testing,course registration will be on hold until placement testing is completed. Students who wish to make changes to an existing schedule are tocomplete a Drop/Add/Withdrawal (DAW) form.1. Registration Year / Term (check one) Fall2. HACC ID Summer (May, June and July)H Spring(Year)(If you were previously assigneda HACC ID, enter it here.)3. Name and mailing address information(Last Name)(First Name)(Street Address)(MI)(Apartment/Lot)(City)(State)(PO Box)(Zip Code)(County)4. School District of Residence5. Contact Information--(Primary Telephone Number)--(Mobile Telephone Number)6. What is your primary educational goal at HACC? (select one) Transfer after completing an associate degree (TCAD) Transfer without completing an associate degree (TWAD) Complete an associate degree (ASOC) Complete a certificate or diploma program (CRDP) Take courses without completing a certificate, diploma or degree. Students mustwork toward a degree, certificate or diploma to receive financial aid. (NODG) Undecided (UNDC)hacc.edu800-ABC-HACCGettysburg Harrisburg Lancaster Lebanonster Lebanon York Virtual Learning 800-ABCAcademically