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    High School Dual Enrollment Application

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    The High School Dual Enrollment Program is for those students who wish to take college classes on a part-time basis while in high school. The classes will either be taught in your high school if you are a student at a partner high school OR you can opt to take classes on RCC's campus on a part-time basis.

    This application is not for Early Admit Students. Early Admit students are high school seniors who enroll full-time in College classes and complete their high school requirements while starting their Associate's degree at RCC. If you are interested in the Early Admit program, please complete our Degree Seeking Application.

    NOTE: You are only required to submit 1 application for the high school program, as long as you have not been inactive for more than 1 year.

    Have you submitted a High School Program Dual Enrollment Application during this past academic year?
    Have you submitted a High School Program Dual Enrollment Application during this past academic year?
    You are only required to submit 1 application for the high school program, as long as you have not been inactive for more than 1 year. If you need to make an update to your application or you are unsure if you need to complete another one, please contact us at admissions@sunyrockland.edu.
    Contact Information
    Address
    Permanent Home Address
    Permanent Home Address
    Do you have a different mailing address?
    Do you have a different mailing address?
    Mailing Address
    Mailing Address
    Biographical Information
    Birthdate*
    Birthdate*
    Residency
    Privacy Protection Policy
    Privacy Protection Policy

    We are committed to protecting your privacy.

    Upon receiving the secure transmission of your Social Security Number, it is immediately encrypted. Only the last 4 digits of your Social Security Number are available in plaintext for identification and account matching purposes. Your Social Security Number is available for decryption only by those officials who oversee automated loading of personal information into student information systems, and only for that limited purpose.

    Our databases are actively monitored and are firewalled to ensure the protection of your personal information, and we employ all industry-standard safeguards.

    Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.         View Definitions
    Definitions

    White: A person having origins in any of the original peoples of Europe, Middle East, or North Africa.

    Black or African American: A person having origins in any of the black racial groups of Africa.

    Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

    Asian: A person having origins in any of the original peoples of the Far East, Southest Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

    American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), who maintains cultural identification though tribal affiliation or community attachment.

    Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

    Race
    Race
    Are you Hispanic or Latino?
    Are you Hispanic or Latino?
    High School Information
    Note: If you are not attending a partner high school that is listed, classes are only available at RCC's campus and regular tuition rates will apply.
    Expected Graduation Date
    Expected Graduation Date
    Application Information
    Please choose which type of High School Dual Enrollment Program you wish to enroll in:
    Note: If you are applying for the Summer semester, all classes are only available at RCC's campus and regular tuition rates will apply.
    Additional Information
    Parent/Legal Guardian Information
    Is this person your emergency contact?
    Is this person your emergency contact?
    Emergency Contact
    Is this person your emergency contact? (hidden)
    Is this person your emergency contact? (hidden)
    Signature
    Student Acknowledgement *

    I have read, understood and agreed with requirements, limitations and procedures of the Rockland Community College High School Program (RCCHSP). I also understand that registration in the RCCHSP will create a permanent academic history and transcript at Rockland Community College. I agree that RCC may release my transcript to my high school without my written permission until I have graduated from high school. I also understand and agree that RCC reserves the right to notify my parents and high school if I become involved in any incident requiring disciplinary action.
    Parent Acknowledgement *

    As the parent or guardian of the RCCHSP student, I too have read, understood and agreed with the requirements, limitations and procedures of the Rockland Community College High School Program (RCCHSP). I also understand and agree with the creation of a permanent academic history and transcript at RCC for my child, the release of my child’s transcript to the high school until my child’s graduation, and the right of the college to notify me if my child becomes involved in any incident requiring disciplinary action. I also understand that some courses may deal with adult content subject matter. Furthermore, I accept full responsibility for all tuition and fees that result from my child’s registration in courses through the RCCHSP.
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