Escolar Documentos
Profissional Documentos
Cultura Documentos
Student's Name
Student's DOB
Dual Enrollment students are encouraged to speak with their Dual Enrollment Coordinator as some programs are identified as
limited access. Note: Once your program objective is declared, changing your primary program objective could negatively
impact your financial aid eligibility. Students receiving veterans benefits must also complete VA form 22-1995 or 22-5495
and submit it to the FSCJ veterans affairs office for process handling.
Current primary program objective:
Program Title: DUAL ENROLLMENT
Indicate the program objective that you want to pursue after high school:
Please be specific refer to the College Areas of Study Web page at fscj.edu/academics/areas-of-study or call us at
904-646-2300 to speak with a representative if unsure of the specific program title and number.
Program Title:
Note that this program will become your new primary objective.
Circle the term/year below to indicate when your new primary program objective is to become effective:
Summer 2015
Fall 2015
City
State
Graduation Date
Parents Signature:
Date:
Student's Signature:
Date:
All signatures are required. Submit this form for processing and handling. We have several ways in which to return
the form: