Award Earned. Did you graduate? Yes

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1 Ac c el er a t edhi g hs c hool S t udent s

2 High School Education High school diploma High school certificate AL occupational diploma Earned GED Year: _ High school: City/State: No diploma or GED Last grade completed: Do you have an Alabama Career Readiness Certificate? No List all universities, colleges, and postsecondary community, junior & technical colleges previously attended. You must report all institutions attended and request official transcripts from each. Name of College City/State Did you graduate? Award Earned Attendance s On Academic Suspension or Probation from this college? Citizenship Are you a citizen of the United States? No Country: Also, enclose a photocopy (front & back) of your resident alien card. Residency Are you a legal resident of the State of Alabama? No State: Current Employment Information Provide CURRENT status and employer information only. Current employer s name: Employment Status Full time Part-time Unemployed Employed in a field related to your program of study? No Not applicable Address: _ City/State/Zip: Phone No., including area code: Occupation/position: _ The information you supply in this section of the admission application is strictly voluntary and will be kept completely confidential. The responses you provide will be used for research purposes and will not be individually listed on any report. If, however, any question requests information that you do not wish to provide, please omit it. Special Populations Status (check all that apply) 1. Is English your second language? No 2. Are you a single parent or a single pregnant woman? No 3. Displaced Homemaker a. Did you work primarily without pay to care for a home and family? No OR Were you dependent on an income from another family member who No is no longer providing that support? b. Is your youngest dependent child age 16 or older? No AND Does he/she receive Family Assistance Program benefits? No c. Are you unemployed or underemployed and experiencing difficulty in No obtaining or upgrading employment? 4. Did your mother and/or father or primary caregiver graduate from a No four-year college? Do you have Internet access in your home? No How did you hear about Faulkner State? Radio commercial TV commercial Direct mail insert Website Billboard Phone book Friend/family member Employer Information mailed to you High school counselor Campus visit Agency (rehab, WIA, etc.) Technical career expo ACT Visit to your high school/career tech center by College personnel

3 CERTIFICATION FORM In-State and Out-of-State Residency Student Name: SSN: Current Address: City: _ County: _ State: Zip: RESIDENCY STATEMENT Please read the following statements and check the ONE statement that applies to you and sign the bottom of the page. I have lived in the state of Alabama for at least the past 12 months. I certify that the address above is my residence and I intend to remain at this address indefinitely. Students cannot attain resident student status simply by attending school for twelve months in the state of Alabama. I am a minor, and my parents/legal guardian(s) have lived in the state of Alabama for at least 12 months. I currently live in one of the following counties of Florida that is within the 50-mile radius of the campus that I wish to attend. I certify that the address and county listed above is my residence and I intend to remain at this address indefinitely. Escambia Santa Rosa I do not currently live in the state of Alabama and I am considered an Out-of-State student. I certify that I do not meet any requirements to be classified as an in-state student. An out-of-state student cannot attain resident student status simply by attending school for twelve months in the state of Alabama. I have currently lived in the state of Alabama for less than 12 months. However, I certify that I possess more substantial connections with the state of Alabama than any other state at the time of this application. I further certify that the address above is my residence and I intend to stay at this address indefinitely. You may be required to provide sufficient documentation to the Director of Admissions. The Director of Admissions must certify all documentation before the in-state tuition rate is official. I certify that I have read the statements above, and I have selected the statement that best meets my qualifications. Signature of Student I understand that withholding required information requested on this application or giving false information could make me ineligible for admission to or continuation at Faulkner State Community College. I agree to abide by the rules, policies, and regulations of the College as stated in the College Catalog. I attest that the information given is accurate and complete to the best of my knowledge. I understand that Faulkner State Community College owns all photographs of students and participants taken at Faulkner State events, and that Faulkner State reserves the right to use these photographs for College promotional materials, both digital and print. If I do not wish to have my photographs used, I understand that I must file a Do Not Use Photograph form with the Faulkner State College Relations Office. Applicant s Signature If under age 18, parent or legal guardian must sign here. Printed name: _ Parent / Legal Guardian s Signature _ Equal Opportunity in Education and Employment It is the official policy of the Alabama Department of Postsecondary Education and Faulkner State Community College that no person shall, on the grounds of race, color, disability, sex, religion, creed, national origin or age be excluded from participation in, denied the benefits of, or be subjected to discrimination under any program, activity, or employment.

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5 Administrator/Administrator Designee Section: ACCELERATED RECOMMENDATION FORM Admissions 1900 U S Highway 31 South Bay Minette, Alabama (251) or (800) ext Student s Name Social Security Number: High School _ Term of Enrollment: Fall Spring Summer Cumulative GPA _ Grade Level The student whose name appears above has met the enrollment criteria for Accelerated High School Students, including completion of 10th grade and a minimum cumulative 3.0 GPA and is hereby recommended to be admitted under the conditions of Alabama State Board Policy Under the Accelerated Program, high school students do not earn high school credits for completing college courses. _ Administrator or Administrator Designee Name _ Administrator or Administrator Designee Signature _ Title of Administrator or Designee _ Student Section: Information Sharing / College Credits I understand that my information and grades may be shared with my legal guardian(s), Faulkner State Community College (FSCC) and with my local high school administration and school board. I further understand that it is my responsibility to provide a final high school transcript to FSCC in order to receive my college credits. Student Signature Parent Section: I understand that it is the responsibility of my child to provide a final high school transcript to Faulkner State Community College (FSCC) in order to receive his/her college credits. Parent Name Parent Signature It is the official policy of the Alabama State Department of Education, including Postsecondary institutions under the control of the State Board of Education, that no person in Alabama shall, on the grounds of race, color, disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment. Revised 08/11/2014

6 Checklist for Accelerated Program Name SS#_ Student ID # High School Term: Fall Spring Summer Year: 20_ Application Accelerated Approval Form (Signed by the Administrator or Designee) Student s Official Transcript to verify passing of 10 th grade and 3.0 cumulative GPA Current /Valid Photo ID (e.g. Driver s License or Passport) *A copy of the ACT score is recommended: An ACT composite score of 18 or higher will exempt qualifying participants from the ASSET Placement Examination and allow students to take college level mathematics and English. Students interested in participating in the Accelerated Program can hand deliver the completed application packet to the Office of the Director of High School Admissions or mail it the following address: Faulkner State Community College 1900 US Hwy 31 South Bay Minette, AL Attn: Office of Director of High School Relations