Wilson Community College CCP Application

Wilson Community College Application:

Career and College Promise Program(CCP) This form is required for current high school students seeking dual admission
Student Information
Student Name*

First NameMiddle NameLast Name
Student First Name*
Student Middle Name
Student Last Name*
Student Date of Birth*

MonthDayYear
Student Date of Birth*
Street Address*

Street Address

CityState / Province

Postal / Zip Code
Student Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Student email address (high school email if available, otherwise personal email)*
example@example.com
Gender:*
Ethnicity (Hispanic/Latino: Mexican, Puerto Rican, Cuban, Central or South American or other Spanish origin or culture, regardless of race). Choose one.*

Hispanic/LatinoNon-Hispanic/Latino
Race*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhiteOther:
College Education Goals*

Transfer Credit to CollegeDegree, Diploma, or CertificateDevelop Job SkillsGoal unknown
Leon's Law:

Under the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, and Leon’s Law, SL 2025-46, Wilson Community College is permitted to disclose information from your education records to your parent(s)/legal guardian(s), without consent, if they claim you as a dependent for federal tax purposes.

To the extent allowed under the Family Educational Rights and Privacy Act (FERPA) and Leon's Law,

(1) My education records will be provided to my parent(s)/legal guardian(s) as long as the parent/legal guardian has not opted out of receiving the education records.

(2) My education records will be provided to the school administrators and school counselors at the school in which I am dually enrolled.
By checking the box, I acknowledge that I have read the statement above regarding Leon's Law.
By checking the box, I acknowledge that I have read the statement above regarding Leon's Law.*

Yes, I acknowledge Leon's Law
Parent/Guardian Contact Information:
Parent/Guardian 1 Full Name:*

First NameLast Name
Parent/Guardian 1 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Email:*
example@example.com
Parent/Guardian 2 Full Name:

First NameLast Name
Parent/Guardian 2 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email:
example@example.com
Emergency Contact Information
Emergency Contact Name*
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Emergency Contact*

MotherFatherGuardianOther:
Academic Information
High School*

BeddingfieldCommunity Christian SchoolFikeGreenfieldHomeschoolHuntSallie B HowardWAVE - Wilson Academy of Virtual EducationWilson Christian AcademyWilson Preparatory AcademyOther:
Current Grade Level (at time of application)*

9 (freshman)10 (sophomore)11 (junior)12 (senior)
Anticipated High School Graduation Date*

MonthDayYear
Date
I certify that all information herein is true and complete to the best of my knowledge. I understand if found to be otherwise, it may cause a delay of admission, loss of credit, and/or dismissal. I acknowledge that the institution may verify the information herein from sources accessible under law to the institution; however, the institution may disclose the contents of this application only as permitted under the Family Educational Rights and Privacy Act of 1994.*

Yes
Information pertaining to your academic record is protected by the Family Educational Rights and Privacy Act of 1974 (FERPA). College personnel are not allowed to disclose information regarding your grades, attendance, or any other academic matter with another person, or in the presence of another person, without your prior written approval. The College may release information to school officials with legitimate educational interest and that information can only be released in accordance with FERPA regulations.*

Yes, I understand
The College expressly prohibits any form of unlawful discrimination or harassment based on sex; race; color; national origin, religion; disability; citizenship; status as a Vietnam era, special disabled, or other covered veteran; or status in any group protected by law.*

Yes, I understand
I understand that college level work requires a high level of maturity, independent learning, and a willingness to take responsibility for completing assignments on time with high quality and academic honesty. I also understand that it is my responsibility to contact the instructor immediately if a circumstance arises that could affect my attendance or completing work on time. I have read the above information, and I agree to abide by WCC’s policies & procedures.*

Yes, I understand
I understand that by enrolling in college courses as a high school student, I am beginning a permanent college transcript. I recognize that my academic performance may impact future eligibility for financial aid, scholarships, college admissions, and eligibility for high school and college athletics.*

Yes, I understand
By signing my name, I (THE STUDENT) am certifying the information in this form is true and accurate to the best of my knowledge.
Clear
Please type your parent or guardian's email address to forward the application information for their signature.
example@example.com
Should be Empty:

Wilson Community College Application:

Student Information

Parent/Guardian Contact Information:

Emergency Contact Information

Academic Information