SouthEast CyberSec Acceptance and Enrollment Form

Congratulations!

Please fill in all of the information below.

Program Contacts:

Your primary program contact is Andrea McLaughlin. If you have any questions or concerns, please be in touch with Andrea at andrea@masshiregreaternewbedford.com or 508.979.1504 x119

Congratulations and we look forward to your success in SouthEast CybserSec in 2019!

Student Name *

First

Middle

Last

Address (Number, Street, City, State, Zip) *

Email *

Telephone Number *

Parent or Guardian Name *

First

Last

Parent or Guardian Email *

High School Name *

Guidance Counselor at School *

First

Last

Guidance Counselor Email *

Guidance Counselor Telephone *

Bristol Community College 900#

This line is only required for students who currently have a 900# with Bristol Community College.

Please read and click all below for affirmation. You must check all in order to be enrolled in SouthEast CybserSec. *

I will complete the Bristol Community College application and follow those instructions
I will adhere to all Bristol Community College dual enrollment procedures.
I intend to complete all courses and events in the SouthEast CyberSec program
I will complete all paperwork necessary for the SouthEast CybserSec program and realize not following the instructions may result in my dismissal from the program.
I am committed to attending all required courses and activities
I have the technology necessary to complete the coursework and activities
If I have any questions or issues in the SouthEast CyberSec program I will contact my professor or the program contact immediately
If under age 18 at the time of enrollment, I have permission from my parent and/or guardian to participate in this program
If graduating from high school before the end of SouthEast CyberSec and I plan on attending another college or university during the time I am enrolled in SouthEast CyberSec, I am responsible for speaking with my college about my enrollment and matriculation in the Certificate in Cybersecurity program at Bristol Community College and how this may affect my student status.

Signature *

Typing your name here indicates your signature for this enrollment.

SouthEast CyberSec Acceptance Page

SouthEast CyberSec Acceptance and Enrollment Form