College in High School Application

College in High School

College in the High School is a partnership between York College of Pennsylvania and Dallastown Area School District. This initiative provides students the opportunity to earn college credit(s) within their high school classroom. This application is only for students participating in this partnership.

Personal Background

First Name

Last Name

Birthdate

Cell Phone Number (Please Include Area Code)

Email Address (please provide a personal email address and not one associated with a school or institution)

It is okay to share visit updates and other important information from York College with me via text message.

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Plan of Study

High School Name

Which Trimester are you applying for?

Spring

Classes

Spring Trimester

Spring Course1 CRN

Spring Course1 Course#

Spring Course1 Title

Winter Trimester

Winter course 1 CRN

Winter Course 1 Course#

Winter Course 1 Title

Parent/Guardian Information

Parent/Guardian #1

First Name

Last Name

Email Address

Do you live with Parent/Guardian #1?

Yes

No

Parent/Guardian #2

First Name

Last Name

Email Address

Do you live with Parent/Guardian #2?

Yes

No

Student Agreement and Consent

I authorize York College to provide my high school any and all information pertaining to my academic record while I am enrolled in York College as a College in the High School student. I hereby release York College from any liability or damage that may result from providing the information requested.

I understand that as a College in the High School student, I must comply with all College policies including requirements for attendance, class, and campus behavior.

I understand that College in the High School students do not qualify for college financial aid and payment of tuition is my responsibility. Additionally, the cost of books and transportation to and from York College is my responsibility. Any collection costs or legal fees if applicable are my responsibility as the student.

I understand by signing this Registration Form I am financially obligated to pay for the course; non-attendance will not remove my charges. I am aware that I must complete a withdrawal form if I wish to leave the course and a refund will not be provided. Should I decide to withdraw from a course, I must notify my high school counselor.

I understand in order to receive college credit at another institution, I need to request and pay for an official York College transcript from the Records Office to be mailed to the college/university that I plan to attend. It is up to the receiving college/university to determine the transferability of those course(s).

From time to time, photographs or video images may be taken at various program activities and those photos and images may be used by York College of Pennsylvania in promotional materials without compensation or further agreement.

I further affirm all claims regarding my legal residence are correct and honestly presented. I have no intention to willfully defraud the College.

In place of your signature, please type your full legal name