NEIU and CCC Guaranteed and Dual Admission Interest Form

YOUR HIGH SCHOOL INFORMATION

High School Name

Graduation Date

YOUR COLLEGE INFORMATION,

Click Add a College/University below to begin entering your college(s) attended.

You must list all colleges/universities or trade-schools attended after high school, regardless of accreditation. Please add any all schools you have attended. Failure to do so may result in dismissal from Northeastern Illinois University.

DeleteCollege/University _ID_
Add all College(s) you attended - Click Add a College/University to add schools
School Name School Country Start Date Start Date End Date End Date Degree Date of Degree Date of Degree School CEEB (hidden) School Level of Study (hidden) To add another college/university, click Add a College/University link below. You must add all colleges/universities attended.

Add a College/University

Credit Earned

Have you earned at least 24 or more college/university credits (from all colleges/universities attended)? Earned hours are courses you've completed and have received grades for. Do not count courses you are currently registered for or in progress.

I have earned 24 or more college credits

I have earned less than 24 college credits

FERPA STATEMENT

Under the Family Education Rights and Privacy Act (FERPA) of 1974, updated February 2009, I understand that my educational records cannot be released without my written permission. I authorize the release of my academic records from Northeastern Illinois University (NEIU) to City Colleges of Chicago (CCC), and the release of any additional academic records from CCC to NEIU, in order to share student data information between the two institutions without the violation of FERPA. I also authorize Northeastern Illinois University to order transcripts from City Colleges of Chicago to facilitate the Dual and Guaranteed Admission process. I understand that I have the right to rescind this release agreement of my academic records at any time by notifying the University Registrar, at Northeastern Illinois University, in writing. My signature indicates that I have read and agree with the above statement.

I understand the FERPA statement and agree to my student records being shared between NEIU and my partner school for the purposes of advising and verifying eligibility for the Guaranteed and Dual Admission program.

Yes, I agree to the FERPA statement

No, I do not agree to the FERPA statement

ADMISSION APPLICATION CERTIFICATION

I understand that withholding information requested on this application, including attendance at any other institution, or giving false information may make me ineligible for admission to Northeastern Illinois University and subject to dismissal if already admitted. I have read and understand all instructions and information on the application. By my electronic signature below, I certify that the statements I have made on this application are correct and complete.

Applicant Signature

Signature Date

CITY COLLEGES OF CHICAGO TRANSCRIPT REQUEST

City Colleges of Chicago Transcripts

Select this checkbox if you'd like NEIU to get your City Colleges of Chicago transcript and pay the fee for you.

To confirm and give NEIU permission to retrieve your CCC transcript on your behalf, please type your name again and provide either your CCC student ID OR the last 4 digits of your SSN, which is required by the CCC transcript fulfillment office.

Select your method method of verification:

CCC Student ID Number

Last 4 digits of your Social Security Number

Enter your CCC Student ID Number Below

Enter the last 4 digits of you Social Security Number below:

My electronic signature below confirms that NEIU may request my CCC transcript on my behalf.