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*Student First Name

*Student Last Name

*High School Attending

* Phone

*Email Address

*Date of Birth

Format: DD/MM/YYYY

*SPC Student ID/Last Four Digits of Social Security Number

*The student’s social security number (SSN) is being requested because it is a unique identification number which is maintained for the purpose of assurance that the correct student record is accessed. The disclosure of such information is voluntary. The disclosure of the social security number will be governed by the Public Information Act (Charter 552 of the Texas Government Code).

*Grade Level

FreshmanSophomoreJuniorSenior

*This semester, will you be concurrently enrolled at another college/university while attending SPC?

YesNo

If yes, name of the institution:

(Upon completion of concurrent enrollment course(s), I understand that I must provide South Plains College with an official college transcript or letter of good standing.) “I understand that by enrolling in a dual credit course or the early admission program, that this is a college level course; therefore, will adhere to all policies of the college. I understand that I am not officially enrolled unless all required registration documents and course payment have been submitted to the college. I further understand that if for any reason I must withdraw from a course I will notify my high school counselor and submit a drop request to the Admissions and Records Office at South Plains College. I hereby give permission for SPC to release my educational record (including but not limited to final grades, account activity and discipline) to my principal and/or counselor in accordance with the Family Education Rights and Privacy Act (FERPA).”

Type Your Name

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