Northeast Alabama Community College PERMISSION TO REGISTER ...

[Pages:1]Northeast Alabama Community College PERMISSION TO REGISTER FOR DUAL ENROLLMENT PROGRAM

Students must submit this form each semester to register for college classes. First time applicants to the program MUST ALSO submit a completed Dual Enrollment Application for Admission, a Release of Student Record Information, a copy of their high school transcript, and provide a valid form of state-issued identification. If adding or changing a course, a new Permission to Register form must be submitted. In order to drop a course, the student must notify Staci Miller and the high school counselor in writing.

Term: _____________ High School Name: _______________________ Graduation Year: ____________ NACC Student Number: ________________ First Name:____________ M.I.: ___ Last Name: _______________

CALL # DEPT CRS# (01742) (CIS) (146)

INSTRUCTOR (HESTER)

M&W T&TH F () () ()

TIME

ONLINE ()

LOCATION (PA 212)

For Office Use Only:

Course schedule is tentative until payment has been received. Please indicate how your tuition will be paid.

Your tuition must be paid before classes begin each semester!

Cash/Check/Credit Card

Workforce Development DE Scholarship (Technical)

Once payment is made and courses begin, I understand that if I withdraw from courses or make an I, D, or F, I will be suspended from the dual enrollment program and will not be allowed to register the following semester. I understand that the courses listed above will be recorded on both my high school and college transcript.

STUDENT'S SIGNATURE: ___________________________

DATE: _______________

ADVISOR SIGNATURE: ___________________________

DATE: _______________

This section is to be completed by the high school guidance counselor and principal.

Once the payment has been received and courses begin, the student must complete coursework. Students

withdrawing from courses or earning a D or F will not be permitted to continue in the dual enrollment program and

will be suspended the following semester. By signing below, I am verifying that the student has met all eligibility

criteria below and is approved to enroll in the above schedule which will be posted on both the high school and

college transcript.

Enrolled in the 10th, 11th, or 12th grade

Please list GPA on a 4.0 scale below: Keyed By:

Has a cumulative 2.5 unweighted GPA Shows academic readiness and maturity

GPA: ___________

High School Guidance Counselor Signature: ________________________________

Date: _____________

High School Principal Signature: __________________________________________

Date: _____________

P.O. Box 159 Rainsville, AL 35986 256-638-4418 Ext 2225 Fax 256-638-6043 millers@nacc.edu | For Office Use Only:

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