WCIP: Early College High School - Dual Enrollment Form

Section A: Program Information

Term/Semester for SUNY Canton course

High School Name

Course Name

Medical Terminology

Are you enrolled at a BOCES campus?

Which BOCES campus are you currently enrolled at?

Course Registration: Select the course(s) in which you are electing to enroll. See the current Course Offerings list for your district & program (BOCES Distance Learning or Dual Enrollment) for a detailed list of courses or contact your High School Guidance Counselor.

Grade Level

Have you ever taken a course through SUNY Canton? (Includes dual enrollment, college class in-person or online, etc.)

What term/semester (ex. Fall 2023) did you take coursework at SUNY Canton?

Section B: Student Information

Last Name

First Name

Middle Name

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number (Mobile)

Email Address

Social Security Number

Birthdate

Gender

Are you a foreign exchange student?

May we release directory information about you?

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Admitted Students

Pay Your Deposit

Open House

Request Information

One-Hop Shop

Departments

WCIP: Early College High School - Dual Enrollment Form