4) On the back side Accepted Documents – If you have an

PCC On-line Dual Enrollment Instructions for Students
If you already have a PCC “A” number (student ID) you DO NOT and SHOULD NOT do this again
You will need to have your Social Security Number to complete the on-line application. Once you receive your student ID,
known as an “A” number”, you will use that for all forms with Pima Community College. You will only use your SSN to
apply online.
1)
2)
3)
4)
5)
6)
Go to www.pima.edu
Go to new student
Apply, How to apply - apply on-line
First time user account creation
Create a log-in ID and PIN (read instructions carefully on how many characters, numbers, etc are required.
Application Type – new First Time College Student or readmit to Pima
Go through every category on the checklist completing all sections. Fill out all boxes required – if you don’t it will take
you back to do so.
For indicating degree – use CT=Certificate, select AZ resident
Planned Course of Study - use one of the following related to the JTED program you will be entering:
Fire Services (Cert), Digital Arts (Cert), Animation (Cert), Culinary Arts (Cert), Early Childhood Education (AAS
Degree), Emergency Medical Technology (Cert), Veterinary Practice Assistant (Cert).
The Residency Affidavit information is very important and needs to be done accurately, and Emergency Contact
information is needed.
Click “Submit” and your “A” number – student ID number will come back to you in a few seconds.
If you have difficulty completing the application and receiving your “A” number, you will need to go to any Pima
Community College campus registration area and the registration staff will help you complete the application process.
After you have completed the PCC On-line Application for Enrollment you will have your student “A” number in order to
complete the Dual Enrollment Form and the Verification of Lawful Presence Form.
Dual Enrollment Permission Form
1) Fill out the top portion with your High School, your name, birthdate, and PCC ID (A Number). DO NOT use your
Social Security Number.
2) Requirements – check all the boxes as appropriate
3) In the middle of the form Pima Community College Course should already be filled in.
4) If not filled in write in the Course Number, Title put the PCC Dual Enrollment course title
5) High School Requirement put the JTED course title.
6) Do the same for Spring
7) Down at the bottom under PERMISSION, sign and date the form.
8) Have your parent/guardian sign and date the Form.
9) Leave the High School Official line blank – Signature not required.
10) Bring the form to your “Cookie with the Teacher” session to turn in.
Verification of Lawful Presence Form
1) Fill out Step One information. Student ID is your Pima “A” number
2) Step Two - Check the appropriate line pertaining to your status.
3) Step Four - Sign and date the form.
4) On the back side Accepted Documents – If you have an Arizona Driver’s license/Instruction Permit or Arizona
Identification from MVD bring it to your “Cookie with the teacher” session and someone will verify the
information in the boxes. If you do not have a driver’s license/permit, you MUST bring your “Birth Certificate” or
a copy of it.. Leave the rest of the form blank including the signature lines.
5) Bring the form to your “Cookie with the Teacher” session to turn in.
PCC Assessment Testing – Assessment Testing for Occupational Dual Enrollment is no longer required unless the PCC
Dual Enrollment course requires a specified level of assessment.
Dual Enrollment 2015 Updated 3/4/15
Verification of Lawful Presence
A student who meets Arizona residency requirements and is legally present in the United States is
eligible for in-state tuition rates. To view residency requirements, go to
www.pima.edu/new-students/apply/residency.html.
Please note: Students also may be required to complete a Residency Affidavit.
➧ STEP ONE: All students must complete this step. Please print.
Name: __________________________________________Date of birth: _______________________
Student ID: ___________________________________________Phone: _______________________
Home address: _____________________________________________________________________
__________________________________________________________________________________
➧ STEP TWO: Any student seeking to qualify for in-state tuition or publicly funded financial aid must
complete this step and present for review one of the documents listed on page two of this form.
If you are not seeking in-state tuition or publicly funded financial aid, proceed to Step Three.
Declaration of Citizenship or Lawful Presence Status
I am (check, if applicable, one of the following):
_____ a citizen of the United States.
_____ an alien with lawful permanent, conditional or temporary resident status.
_____ an alien in a nonimmigrant visa status, and the initial period of admission either has not expired
or has been extended. Visa type: _____________________.
_____ an alien in a refugee or asylee status, that has not been revoked.
_____ an alien in a parole status, that has not expired, been revoked or been terminated.
_____ an undocumented student with deferred action (DACA) status.
➧ STEP THREE: Students not seeking in-state tuition or publicly funded financial aid may complete this step.
_____ I do not wish to be considered for in-state tuition rates or publicly funded financial aid.
➧ STEP FOUR: All students must complete this step.
Sworn Statement
By signing below, I swear under penalty of law that the information provided in this declaration is true and
correct and all documents presented are genuine. I understand that false or misleading information or documents related to this declaration may subject me to expulsion from the College as well as legal sanctions.
Signature ______________________________________________Date _______________________
continued
Student ID:__________________________
ACCEPTED DOCUMENTS
Any student seeking in-state tuition or publicly funded financial aid must present one of the following
documents to an authorized College employee for review. Only an original document or a copy certified
by the issuing agency is considered valid for review. Unofficial photocopies are not acceptable. The
document must be in English.
1. An Arizona driver license issued after 1996 or an Arizona nonoperating identification license.
2. A birth certificate or delayed birth certificate issued in any state, territory or possession of the United
States.
3. A United States certificate of birth abroad.
4. A United States passport.
5. A foreign passport with a United States visa.
6. An I-94 form with a photograph.
7. A United States citizenship and immigration services employment authorization document or
refugee travel document.
8. A United States certificate of naturalization.
9. A United States certificate of citizenship.
10. A tribal certificate of American Indian/Alaska Native blood.
11. A tribal or U.S. Bureau of Indian Affairs affidavit of birth.
12. A current I-766 Employment Authorization Document demonstrating approved DACA status.
The following is to be completed by an authorized College employee.
Review document to verify the student's declaration of citizenship or lawful presence status.
Document
Title
Issuing
Authority
Document
No. (if any)
Expiration
Date (if any)
I have examined the document described above that was presented by the student.
The document: (1) appears to be a genuine original document or a copy certified by the issuing agency,
and (2) relates to the student.
Printed name of authorized College employee _____________________________________________
______________________________________________________Date: _______________________
Signature of authorized College employee
Pima Community College is an equal opportunity, affirmative action employer and educational institution committed to excellence through diversity. Upon request, reasonable
accommodations will be made for individuals with disabilities. Every effort will be made to provide reasonable accommodations in a timely manner. For public and employee
accommodation requests, as well as information related to the ADA complaint process, contact the College ADA Coordinator at (520) 206-4539 or 4905C E. Broadway Blvd.,
Tucson, AZ 85709-1130. For PCC student accommodation requests, please contact the appropriate campus Disabled Student Resource office (520) 206-4500 (TTY 520-206-4530).
1404BL4D
Pima Community College
Dual Enrollment Permission Form
Student Information (Please Print)
High School: ________________________________________________________
__________________________________
(Matriculation Number)
Student Name _______________________________________________________
First
MI
Last
__________________________________
(PCC ID)
Note: Students younger than 16 must have permission of the appropriate PCC campus Vice President of Student
Development.
_______-_______-_______
(Date of birth)
_____________________________________________________________
Campus Vice President of Student Development
Date
Requirements:
1. High school approval is required prior to PCC course registration if the PCC course(s) are to be used for high school
graduation credit. Note: Three (3) PCC credits generally equals one-half (1/2) a high school credit.
2. To qualify the students must meet all of the minimum criteria:
Be enrolled in at least four (4) high school courses for the semester not including the Dual enrollment course.
Be in grade 11th or 12th (Note limited exceptions for 10th grade)
Completed the College’s assessments if required and received the required course placement recommendations for
any courses requiring specific placement scores. Some DE classes do not require assessments.
3.
Met all course prerequisites
Identify the PCC Dual Enrollment courses you intend to complete this academic year
Pima Community College Course
High School Requirement
Fall
_2015___ _EMT 110, 159_____ __First Responder, CPR: HC________ __Emer. Medical Tech__________________
(Year)
(Course Number)
(Title)
(Requirement)
_______ _______________ ____________________________________ _________________________________
(Year)
(Course Number)
(Title)
(Requirement)
Spring
_2016_
(Year)
_EMT 110, 115_(3.5 cr.)
(Course Number)
_First Responder, CPR: HC________
(Title)
__Emer. Medical Tech. (continued)______
(Requirement)
_______ _____________ ________________________________________ _____________________________________
(Year)
(Course Number)
(Title)
(Requirement)
PERMISSION Signatures are required by the following:
I give permission to Pima Community College to share academic information with my high school.
___________________________________________________
Student
Date
_______________________________________________
Parent or guardian
Date
___________________________________________________
(High School Official)
_______________________________________________
Title
Date