Dual Enrollment Registration Student InformationName(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Personal Email(Required) School Email(Required) Cell Phone(Required)Home PhoneParent / Guardian InformationName(Required) First Last Email(Required) Phone(Required)High School InformationHigh School Name(Required) First High School City & State(Required) City State / Province / Region Graduation Year(Required)High School Counselor Name(Required) First High School Counselor Email Votech / Career Center Name First Eligibility Details Students wishing to enroll in Dual Enrollment/College in High School courses at Pittsburgh Technical College must demonstrate college readiness by achieving one of the following: ACCUPLACER Quantitative Reasoning, Algebra, and Statistics test score of 236 AND ACCUPLACER Writing test score of 237 OR ACT math score of 14 AND ACT English score of 13 OR SAT math score of 360 AND SAT Reading score of 19 (correlations cannot be made to any other SAT test score) Choose one:(Required) I will take the Accuplacer exam at no cost I will submit qualifying SAT scores that show my eligibility to register for a PTC course(s) I will submit qualifying ACT scores that show my eligibility to register for a PTC course(s) Please select your testing preference:(Required) I will take the exam at Pittsburgh Technical College after school (Tuesday/Thursday during the school year) or on the one provided Saturday during September. I will take the exam virtually during the school day. I will take the exam virtually after school. I will take the exam in-person at my high school (only available for groups of 11 or more students per high school per day). Consent Agreement By completing this form and submitting it to PTC, you are providing your express consent for the following: PTC to contact you, at the number provided, about its programs using a variety of methods including phone (both mobile or home, dialed manually or automatically), email, mail, and text message until PTC is notified otherwise. You are not required to provide consent in order to attend PTC. Pittsburgh Technical College (hereinafter PTC;) cannot prevent you and/or your child from becoming exposed to, contracting, or spreading COVID-19 while utilizing PTC’s services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize PTC’s services and/or enter onto PTC’s premises you may be exposing yourself and/or your child to and/or increasing your risk of contracting or spreading COVID-19. I recognize that during the event, injury and/or illness to myself/my child and/or property may result. I release Pittsburgh Technical College, and its staff and faculty, and hold them harmless from all and any manner of liability, loss, or expense arising out of injury and/or illness to myself/my child or loss of or injury to my/my child’s property occurring while engaged in the event above described. I understand that there is no medical expense payment coverage available for participants in Pittsburgh Technical College events. I agree and consent that Pittsburgh Technical College may, at its discretion, publish or use photos or videos of myself and/or my child for reference, publicity, or advertising purposes without any consideration or liability whatsoever. Nondescrimination Policy Δ