JSCC and UT Martin Dual Admissions Intent to Participate

Student First Name

Student Last Name

Birthdate

Student Mobile Phone

Student Email Address

I plan to attend my first class at UTM

Which UT Martin location do you plan to attend?

Intended Major: Martin

Intended Major: Online

Intended Major: Springfield

Intended Major: Jackson State or Ripley

Intended Major: Parsons

Intended Major: Somerville

Recruit Student Type

Acknowledgment and Signature:

As a participant in this program, you are subject to the same admission, matriculation, disciplinary and degree requirements governing all other UTM and JSCC students.

This is an admissions agreement that does not include any particular program or major. This statement of Intent to Participate will also serve as a Release of Information that authorizes the institutions to share appropriate admission, financial, academic and advising information concerning the enrollment and performance of the student. You are agreeing to abide by the policies and procedures of the Dual Admissions Program, JSCC and UTM.

Academic Advising: Knowing the important role that academic advising plays in a student's success, counselors and advisors at JSCC and UTM are available to assist you in tailoring your program of study to meet your educational goals. If you change your major, you will need to notify your academic advisor at JSCC and UTM.

I acknowledge the above terms and conditions.

Student Signature:

Parent/Guardian Signature: