UA Early College Student Information Form

This Student Information Form is a required component of your application to UA Early College. Please complete all questions. If you need help call our office at 205-348-7083. Our office hours are Monday-Friday, 8:00 AM - 4:45 PM.

Student Information

First Name

Middle Name

Last Name

Preferred First Name

Student Personal Email

Student Cell Phone (10 digit number)

Student Home Phone (10 digit number) - not required

Birthdate *

Parent/Guardian Information #1

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone Number (10 digit number)

UA Early College only sends texts to remind parents/guardians of important academic deadlines and other relevant dates related to their student’s involvement in the program. However, most text/SMS messages are sent to the student if permission is given for the student phone number.

Permission to Text (SMS)?

Yes

No

Is the student a dependent of a University of Alabama faculty or staff member?

Yes

No

University of Alabama faculty/staff and their dependents may be eligible for additional tuition benefits through the Educational Benefit. The Educational Benefit Form must be completed by the appropriate deadline outlined by Human Resources for the benefit to apply for the upcoming semester. Contact the Human Resources Service Center at 205-348-7732 or hrsvctr@ua.edu to learn more about how you can combine the UA Early College partial tuition scholarship with your faculty/staff dependent educational benefit. If both parents/guardians are employed at UA, please provide the below information for both.

**Providing the faculty/staff information above does NOT replace the necessity to complete the Educational Benefit Form through UA Human Resources.

UA Faculty/Staff First and Last Name:

UA Faculty/Staff CWID:

Additional UA Faculty/Staff First and Last Name (optional):

Additional UA Faculty/Staff CWID (optional) (8 digit number):

Parent/Guardian Information #2

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone Number (10 digit number)

UA Early College only sends texts to remind parents/guardians of important academic deadlines and other relevant dates related to their student’s involvement in the program. However, most text/SMS messages are sent to the student if permission is given for the student phone number.

Permission to Text (SMS)?

Yes

No

High School Information

Type of High School

Name of High School (Please Select from the list)

Counselor Name (First and Last Name)

Anticipated High School Graduation Year

Anticipated College Interest

How did you hear about UA Early College?

UAEC College Readiness Course Session

The UAEC 200 College Readiness Course first class session is a one-time class meeting with your instructor and classmates. Students and parents are required to attend. You have the opportunity to attend this first class session on The University of Alabama campus or online. Following the first class meeting, students will continue working through the UAEC 200 course online for the next five weeks.

Choose a first class meeting day/time/location from the drop-down below.

UAEC 200 College Readiness Course Session

Acknowledgements

I verify that I have regular access (minimum of 4 to 5 days a week) to:

A reliable computer (PC or Mac is preferred as they are most compatible with Blackboard and other required software.)

With high speed internet

And working computer speakers or headphones

UAEC 200 First Class Meeting:

I acknowledge that my UAEC 200 class begins on the first class meeting date selected above.

UAEC 200 Course Duration and Credit:

I acknowledge that this course is a 5-week course worth 2 hours of college credit.

UAEC 200 Date Change Procedure:

Students admitted to the UA Early College program will have one additional opportunity to move or change UAEC 200 start dates. After one date change, students will be required to re-apply to UA Early College and pay the $40 application fee. It is important for students to examine their high school, work, extracurricular, and other schedules before selecting a UAEC 200 date.

UAEC 200 Failure Policy:

UA Early College students must earn 700 total course points and submit the College Research Paper to earn a "P" passing grade for UAEC 200. Students must earn at least 750 points, submit the College Research Paper, and complete the Academic Advising Interactives and Session to be eligible to take future UA Early College classes.

Students who fail to earn 700 points (or fail the UAEC 200 course) will be required to retake UAEC 200 and pay the UA Early College tuition rates for the course.

By submitting this information form, I certify that the above information is true, correct, and complete at time of submission. I will promptly inform The University if there is a change to any of the responses in this application, including new or additional information.

Signature