Dual Enrollment Registration Form

Step 1: STUDENT INFORMATION
Name ______________________________________

High School: _________________________________

College Student ID # _______________________

Grade Level _______________________

I am submitting this approval form for the following semester and year:
□FALL	□ SPRING	□ SUMMER 20__ __	For the ___________ Campus CCC/FCC/RC

Step 2: HIGH SCHOOL APPROVAL

5 Digit Course #
	Course Title
	Units

			

Total

If you are a student with a documented disability (i.e., IEP, 504 plan, etc.) and/or you would like to know about accommodations available for the college course for which you are enrolling, please contact Disabled Students Programs and Services (DSP&S) at 325-5230 (Clovis Community College), 442-8237 (Fresno City College), or 638-3332 (Reedley College) for more information.

Please Attach a High School Transcript. Forms without Transcripts will not be processed.

High School Principal / Counselor- by signing below you acknowledge the following:

□ I have reviewed the academic record of the above-named student and certify that the student demonstrates adequate preparation in the course(s) listed and can benefit from advanced scholastic education. (Education Code 48800 (a))
□ SUMMER ONLY: I certify that I am limiting the number of recommendations to no more than five percent of the total number of pupils who completed the grade immediately prior to the time of the recommendation for summer session. (Education Code 48800 (d))

High School Principal Signature: __________________________ Print Name: ________________________________ High School Counselor Signature: _________________________ Print Name: ________________________________ Date: ______________________	Contact Phone: ______________________________________________________

For Office Use Only:
 Student is participating in an AB 288 pathway (15 unit maximum)
DuE:  Application  HS Transcripts	 Signatures	DuE verified:___________________________ (Please Print)

A&R:  Registered  STMC  SPRO/Dual.HS program Date Entered:_________ By:_________________________

(Please Print)

Step 3: STUDENT AGREEMENT
By signing below you acknowledge you have read and understand the following:
 	All SCCCD Dual Enrollment students are responsible for complying with the rules and regulations of the college as published in the FCC/RC/CCC catalog(s) and schedule(s) of classes. Please review these rules and regulations with your parent or guardian to ensure you have a successful experience.
 	Grades: By participating in a dual enrollment course you are creating a college transcript. The grade(s) you earn in your SCCCD class(es) will become a part of your official college academic record.
 	 Students participating in Dual enrollment must make satisfactory academic progress (minimum cumulative GPA of 2.0 and completion of 51% of courses attempted) to maintain eligibility for financial aid when they begin college as a post graduate student (after high school graduation).
Please note: The College has the right to restrict enrollment for reasons of health and safety, preparedness of the student, availability and college board policy. (References- California Education Code: Sections 48800-48802, 76001, 76300)

Student Signature: ______________________ Print Name: ________________________ Date:_________

Step 4: PARENT AGREEMENT
By signing below you acknowledge you have read and understand the following:
 	Student Records: Under Section 49061 of the Education Code, parents of community college students do not have a right of access to their children’s student records, regardless of whether the student is under the age of 18. In accordance with this regulation, students’ college records will be released to parents only with the written consent of the student. (Family Educational Rights and Privacy Act (FERPA) Authorization for Release of Information form may be obtained at Admissions &Records)
 	Contacting Instructors: Your student is enrolled in a college course and it is important to understand that instructors work directly with students, as opposed to the type of parent interventions you may be accustomed to at the high school level. Under FERPA instructors are not required to discuss student performance or other student-related issues with parents.
 	 Course Content/ Material: Dual enrollment courses are taught to the rigor of a college course. Students will be using the same textbooks and syllabi as they would if they were taking a class on a college campus. As such, please be aware that discussion topics and course materials are generally designed for adult students and may not be appropriate for younger students.
 	 Your son/daughter will receive no special consideration because s/he is a high school student and will be subject to the rules, regulations, and policies of the State Center Community College District.

YOU MUST SELECT ONE OF THE FOLLOWING:
  I authorize SCCCD to release my student’s final grades to their high school Registrar.
  I DO NOT authorize SCCCD to release my student’s final grades to their high school Registrar.

NOTE: If you opt out, your student’s high school may request that your student provide the registrar with an official SCCCD transcript before giving credit towards high school requirements/graduation.

Parent / Guardian Signature: ________________________ Print Name:________________________ Date:_________

Portions of this form were adapted from Santa Barbara City College’s Dual Enrollment Materials

Form Revised 9/26/2018