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Concurrent Enrollment Agreement and Registration Form 2013

Concurrent Enrollment Agreement and Registration Form 2013

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Published by Ehs Dean

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Published by: Ehs Dean on Oct 01, 2012
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Revised: August, 2012
Concurrent Enrollment Program Agreement and Registration Form
You have indicated that you are interested in enrolling in a college course while a high school student. The State of Colorado providesseveral options for high school students who meet high school standards to begin college early. The purpose of these options includepromoting content standards, providing academic challenge and enrichment, and providing access to academic courses that may not beavailable at a local high school to meet high school graduation requirements.Persons under twenty-one years of age, enrolled in 11
or 12
grade who demonstrate academic preparedness and are not a 5
yearsenior, are eligible for the Concurrent Enrollment Program. Students may not enroll in college level remedial or basic skills courses. Toenroll at an eligible post-secondary institution a student must have completed the minimum course prerequisites and all requiredassessments. 5
year seniors who apply and are accepted for college courses, are financially responsible for tuition and all associatedcosts.St. Vrain Valley School District will pay the student share of tuition
minus Colorado Opportunity Fund (COF)
if the student passes acourse with a grade of “C” or better.
Tuition is available for one or two courses per semester.
The District is not responsible forpayment of any additional fees other than tuition. Specifically the District will not reimburse for course related books, materialsand fees. *Some fees may be waived if location of class is off campus at a high school. Please check with your counselor forspecifics.
The District must be notified 60 days in advance of the start of the semester of a student’s registration. Concurrent Enrollmentdoes not include enrollment in on-line courses, correspondence courses, courses offered during the summer session, or evening courses.
Payment of Tuition
A student is responsible for payment of tuition using the District’s RevTrak system. Tuition payment is due by the drop deadline for theclass. Additional fees owed to the college must be paid directly to the college and are the student’s responsibility.The RevTrak site can be reached by going tohttp://stvrain.revtrak.netor by using the “online payments” link from the “parents” or“quick links” menu on the St. Vrain Valley School District homepage. Once at the RevTrak site, the Concurrent Enrollment paymentspage can be accessed by clicking on the “Register for Selected Programs” then clicking on the “Concurrent Enrollment RegistrationPayments.”
SECTION A: To be completed by student (PLEASE PRINT)
Name of Student __________________________________________________________ Term/Semester__________ 20_____College Student ID # _____________________ SASID # _______________________ Student ID # ___________________Address _______________________________ City ___________________________ Zip Code ______________________Phone # ___________________ Email __________________________ Name of Parent/Guardian _____________________________Date of Birth _____________________ Current Age ____________ High School ___________________________College attending for Concurrent Enrollment Course(s) (Please check one)
Course Selection (**Student must apply for classes each Semester)Subject CourseNumberTitle CreditHoursCourse Location(HS/College)CounselorInitials
 MAT 120 Math for Liberal Arts (EXAMPLE) 3 College tbd 
Alternative Choice (if class(es) not available)
______ Front Range Community College ______ Front Range on Campus at _______ ______ University of Colorado, Boulder
Revised: August, 2012
SECTION B: To be read by Student and student’s Parent/Guardian
Signatures below indicate that you wish the above named student to participate in the Concurrent Enrollment Program by enrolling incollege courses. In addition, you/your student understand your signatures below indicate you/your student understand and are inagreement with the following:
Advice and counsel regarding such participation has been received from the student’s current high school.
The student understands that he/she may enroll in Guarantee Transfer courses and/or courses which apply to a specific pathwayas long as they or an equivalent are not available in their high school or school district.
The student will meet the same course expectations and prerequisites as college students, as noted in the course catalog and/oron the class syllabus.
The grade(s) received in course(s) will appear on the student’s official high school and college transcripts.
Course credits may transfer if the student earns a “C” or better in a Guarantee Transfer course, or a course accepted by a postsecondary institution.
If a student withdraws from a course at the college after the drop/add date, they will receive a “W” or “F” on their collegetranscript. In addition, if a student receives a “D” or “Incomplete” in one or more classes after the drop/add date, the studentand parent/guardian will be responsible to St. Vrain Valley School District (SVVSD) for the full payment/reimbursement of tuition for the respective course(s).
The course(s) satisfy college degree requirements and align with the student’s Individual Career & Academic Plan (ICAP).
With regard to college activities, qualified students may participate in activities but are not eligible for NCAA athleticactivities.
The student will need to register for College Opportunity Funding (COF) and understands the credits earned will be deductedfrom the COF lifetime account at institutions which receive COF funding.
Signatures indicate authorization of my College Opportunity Fund (COF) to the College. I authorize the high school/schoolSVVSD to release my SASID # to the college for the purpose of COF, at institutions which receive COF funding.
In compliance with the
Family Educational Rights and Privacy Act (FERPA) of 1974
, the student gives permission to theabove noted college to report absences, disciplinary issues, and the release of grades, transcripts, in progress grades, and classschedules, as available, to the above noted high school for the courses enrolled under the Concurrent Enrollment Program.
If enrolling in a Concurrent Enrollment class somewhere other than the local community college (i.e. CU), the studentwould only be eligible for the amount of tuition at the local community college tuition rate. The payment of any tuitioncharged above the community college rate will be the responsibility of the parent(s). The College will bill the studentfor the remaining tuition. This includes the change of enrollment from a community college to a four year collegeregardless of the reason/circumstance (i.e. does not fit schedule, not offered at community college, etc.)
I wish to pay my own tuition. (Applies to students who are ineligible for Concurrent Enrollment.) Note: The District does not paytuition for home school students unless they are enrolled as a part-time student – a minimum of 2 courses. The District will reimburse amaximum of 6 credits to home school students. 
All males between the ages of 17yrs 11mos and 26yrs* must answer this question. *Age atthe start of class. Are you registered with Selective Service? (For more Information:www.sss.gov)
Yes No
This agreement is student and college specific. A separateagreement and college application must be completed for each eligible post-secondary institution the high school student plans to attend.
In signing this agreement, I authorize the college to release my transcript to my school district at the end of the course and agree to allinformation under Sections A and B.____________________________________________________ ____________________________________________________Student Signature and Date Parent/Guardian Signature and Date

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