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5092700114301001181100000left000 Delaware City Schools & Delaware Area Career CenterINTENT TO PARTICIPATE(To Be Signed Front and Back and returned by MAY 1st. Please PRINT LEGIBLY.)Date _______________________________________________________________________________ AFTER MAY 1, YOU WILL NEED PERMISSION FROM THE PRINCIPAL TO PARTICIPATE. Student Name: _________________________________ Grade Level for Next School Year: __________School (Circle one): Participating in (Circle one): Hayes HS Dempsey MS Option A (Self-Pay) or Option B (School Funded)Plan to take classes CCP Classes at (Circle all that apply): Does the student have an IEP or 504 Plan?Hayes Online Campus (Circle one): No IEP 504 Plan (Students on IEP’s or 504 Plans must register with theTerm of initial enrollment (Circle one): College’s Office of Disability Services if they wish to receive accommodations in College Credit Plus courses.) Summer Fall Spring Please circle the college(s) are you planning to apply for College Credit Plus coursework:The Ohio State University – Main CampusColumbus State Community College Will DCS need to provide transportation to the CSCC-Delaware Campus? (Circle one): Yes NoThe Ohio State University – Marion CampusMarion Technical CollegeOtterbein University Other: __________________________Please circle any CCP courses you plan to take that are offered at Hayes High School: Columbus State Community College Otterbein University School of Business Courses Music Theory Marion Technical College BlockWhich courses do you plan to take ? (Circle All Courses below or the specific ones, if not taking all courses)All Courses in MTC Block -OR-Comp 1 Comp 2 Psychology Sociology Ethnic & Cultural Diversity Skills for Success Parent/Guardian Name ________________________________________________________________Home Address _______________________________________________________________________Parent Phone Number (Day)_________________________(Evening)____________________________ Parent Email Address __________________________________________________________________I would like to declare my intent to participate in the College Credit Plus program. I understand that signing this form does not require that I participate during the coming school year and I may decide not to participate without consequence. I also understand that it is my responsibility to notify my school if I do not gain admission to my selected institution of higher education or choose not to participate for some other reason. In addition, I certify that I have received counseling about the College Credit Plus program concerning program eligibility, the process for granting academic credit, financial arrangements for tuition/fees and textbooks, scheduling of courses at the high school or middle school, the effects of the program participation on my graduation requirements, and the effects of participation on my grade point average and athletic eligibility, and all other rules and regulations for both my school and the college, and that I understand my responsibilities, the benefits and possible risks of participating in the College Credit Plus program. Student Signature _____________________________________________________________________Parent Signature ______________________________________________________________________(Please turn over for additional information and signatures needed) 5092700114301001181100000left000(Continued)I, _______________________, the parent/guardian of _____________________ understand we have the following responsibilites:I have attended an informational meeting, counseling session, and/or reviewed the Delaware City Schools College Credit Plus website to understand the rules and regulations of College Credit Plus.LINK TO GENERAL CCP OVERVIEW VIDEOLINK TO HAYES CCP OVERVIEW VIDEO (Link to Google Slide Presentation) (Link to Google Slide Presentation)Apply to any and all chosen colleges prior to the college’s deadline and achieve the minimum requirements for admission including taking any and all required placement tests, such as Accuplacer, ALEKS, ACT, or municate all College Credit Plus plans with the College & Career Counselor prior to enrolling in courses to ensure graduation requirements will be met. Many schools require a form to be signed by the College & Career Counselor and submitted with a transcript prior to a student registering for courses.Provide a schedule of courses and list of textbooks needed to the College & Career Counselor prior to the start of a given semester (Delaware City Schools or DACC will purchase all books based on the lists provided, students and parents should not purchase their own textbooks, regardless of what a college advises.) Communicate with the student’s college regarding registering for courses. Withdraw from a course, if desired, by the on-time withdrawal date of the college. Provide reimbursement to Delaware City Schools (or DACC if DACC has provided the CCP course) for any failed course or one dropped after the 15th calendar day of the semester. Reimbursement includes textbook and tuition costs for that course. Provide transportation to and from college courses taken on a college’s campus. (Transportation Waiver form also needs to be completed and turned in if student is taking courses on a college campus.)Print Full Parent Name _________________________________________________________________Parent Signature _____________________________________________________ Date ____________This form is valid for one school year and must be signed each year of CCP participation. ................
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