Everett Community College Running Start Application

Everett Community College Running Start Application
Name: ___________________________________________________ Social Security Number: ________-______-__________
LAST
FIRST
 Check here if you wish not to disclose
MIDDLE INITIAL
Email (required): ________________________________________________________________________________________
Gender: __________________ Birthdate: ___________________________ Phone: (_______) _________________________
Address: _______________________________________________________________________________________________
City: ___________________________________________________ State: ______________________Zip: ________________
Did your parent or guardian earn a Bachelor's degree from a U.S. college or university?
What quarter do you plan to start Running Start?
 Fall
Voluntary Information:
What race do you consider yourself to be?
 White (800)
 Black or African-American (870)
 Alaskan Native or American Indian (597)
 Chinese (605)
 Filipino (608)
 Other Asian or Pacific Islander (621)
 Korean (612)
 Vietnamese (610)
 Japanese (611)
 Other race (799)
 ___________________________________
Are you of Spanish/Hispanic origin?
 Yes (717)  No (999)
RUNNING START APPLICATION PROCEDURES
1.
2.
3.
4.
Discuss Running Start with your high school counselor and
parent/guardian before deciding whether to apply.
Take the placement test (schedule available at www.
everettcc.edu/testing). Students have the choice of either taking
the Asset (a timed, paper-and-pencil test) or the Compass (a
computerized, untimed test), but they must take all three parts
(Reading, Writing, and Math). The placement test costs $30.
Students may take the Placement Test 3 times in a 2 year period.
Obtain Everett Community College Running Start application
from high school counselor. Application must be signed by
student, parent and high school counselor.
Submit signed application and test scores to Everett Community
College; Attention Running Start. Applications submitted by the
dates below will be given priority processing and registration.
Everett Community College
Running Start Program
2000 Tower St
Everett, WA 98201-1390
5.
Check Your Email: Once application has been reviewed and
processed, student will receive information about orientation via
email.
PRIORITY APPLICATION DEADLINES
•
Fall – May 1
•
Winter – November 1
•
Spring – February 1
 Yes  No
 Check here if interested in the ORCA program.
 Winter  Spring
FOR COLLEGE USE ONLY
YRQ:______________________________________________________
HS: _______________________________________________________
SID: _______________________________________________________
 Full
 HDEV101
 Need Test Scores
 Need Signature
STUDENT
I have read the Everett Community College Running Start Admissions
Policy and agree to the Contract on the back of this form.
Student Signature: ___________________________________________
Date: ______________________________________________________
PARENT OR GUARDIAN
I am aware that the student has applied for admissions to the Running
Start Program and I have read, understand and will comply with the
Running Start Contract on the back of this form.
Parent/Guardian Signature: ____________________________________
Date: ______________________________________________________
HIGH SCHOOL
This student is enrolled in ______________________________________
High School and will begin Running Start as a  Junior  Senior
Counselor’s name (print): ______________________________________
Signature: __________________________________________________
Date: ______________________________________________________
SCHOOL DISTRICT (for Homeschool Students only)
The student is considered a  Junior  Senior for the purposes of
enrolling in the Running Start Program. The student is registered with
_______________________________ School District.
Name (print): _______________________________________________
Signature: __________________________________________________
Date: ______________________________________________________
To comply with federal law, we are required to ask for your Social Security Number (SSN) or Individual
Taxpayer Identification Number (ITIN). We will use your SSN/ITIN to report Hope Scholarship/Lifetime tax
credit, to administer state/federal financial aid, to verify enrollment, degree and academic transcript records,
and to conduct institutional research. If you do not submit your SSN/ITIN, you will not be denied access to the
college; however, you may be subject to civil penalties (refer to Internal Revenue Service Treasury Regulations
1.6050S-1(e)(4) for more information). Pursuant to state law (RCW 28B.10.042) and federal law (Family
Educational Rights and Privacy Act), the college will protect your SSN from unauthorized use and/or disclosure.
RUNNING START STUDENT PARTICIPATION ACKNOWLEDGEMENT
By signing the front of this application, I understand and agree to all of the following statements:
1. This application serves as a universal permission slip. Some classes and/or clubs will have field trips and by signing this form, I am aware of the
possibility of the Running Start student traveling away from Everett Community College for the educational and/or extracurricular purposes.
2. Students will follow and adhere to the Student Code of Conduct.
3. Students must maintain a 2.0 GPA. If grades are below a 2.0 GPA for three quarters, the student could lose the Running Start Funding.
4. Running Start does not pay for non-tuition costs such as books, fees, parking, transportation, and tuition for classes under the 100 level. Fee
Waivers are available for eligible students by filling out a Fee Waiver Application and providing documentation.
5. All Everett Community College courses will become part of the student’s permanent record. Only students have access to their own college grades
and records. To obtain student grades or records, parents/guardians should work in cooperation with their student.
6. As a public, state institution of higher education in pursuit of academic excellence and the advancement of intellectual discourse, Everett
Community College welcomes the expression of diverse and opposing views and opinions that challenge and foster the expansion of student
minds, often pushing the boundaries of comfort. This adult environment includes diverse and potentially irreconcilable viewpoints expressed
through language, course readings and material both in and out of the classroom. Instructors are not required to substitute assignments if the
student chooses not to complete them.
7. Instructors are not notified who is a Running Start student. Students are not expected to share this information unless they so desire. In accordance
with Federal Education Right to Privacy Act (FERPA), instructors will not notify parents/guardians when a student is failing or not attending a class.
8. Students are responsible for meeting all high school graduation requirements and for determining how high school and Everett Community College
courses meet two-year and four-year college requirements and specific program requirements.
9. Students are responsible for arranging their college schedule so it does not conflict with their high school schedule. Instructors are under no
obligation to grant exceptions for high school commitments/activities which conflict with college classes/assignments/expectations.
10. Before changing your schedule you should consult with your high school counselor.
11. Running Start students are not permitted to “Audit” a class.
12. If a student withdraws after the second week of the quarter a “W” grade will appear on the student’s college transcript and no credit is earned. If a
student does not officially withdraw, s/he may receive a 0.0 on their permanent college transcript. It is not desirable to have a college transcript with
many or a pattern of “W” grades.
13. The maximum number of credits paid by Running Start is based on high school enrollment. You must complete a quarterly Running Start
Enrollment Verification Form. This form will indicate my maximum credit eligibility.
QUESTIONS?
Email: highschoolrelations@everettcc.edu
Web: www.everettcc.edu/RunningStart
Phone: (425) 388-9008 or (425) 388-9073
Fax: (425) 388-9173
Everett Community College does not discriminate on the basis of race, religion, creed, color, national origin, age, sex, sexual orientation, marital status, the presence of any physical, sensory or
mental disability, or status as a disabled or Vietnam era veteran in its program and activities, or employment. The Vice President of Student Services has been designated to handle inquiries
regarding student-related non-discrimination policies and can be reached at 2000 Tower Street, Everett, WA 98201, or by phone at (425)388-9589.