MONTCALM
COMMUNITY COLLEGE
Dual Enrollment
Application for Registration Authorization
For enrollment at Montcalm Community College - Semester:
q Fall q
Spring Year:_____
Section 1: To be completed by student and parent/guardian:
| Name: (Last, First, MI) | Social Security #: | Telephone:
( ) |
| Address: | City/Zip: | Birthdate: |
| Parent/Guardian Name: | Address (if different from above): | |
| Parent/Guardian
and Student verification: We have received information about
Dual Enrollment and are aware of the counseling services available at our
local high school. We acknowledge that there are responsibilities
and consequences involved in the program including: grades earned
may effect academic standing at both the high school and the institution;
there is no guarantee that courses completed under this program will be
accepted by any other college or university; and, it is the student's
responsibility to provide final grades to the high school to verify credit,
failure to do so may jeopardize high school graduation. In signing
below, we give permission for MCC to release all grade and attendance information
to the high school.
Parent:__________________________ Date:___________ Student:_____________________ Date:___________ |
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Section II: To be completed by the high school:
Name of High School: ______________________________________________| HS Counselor : | Title: | Phone: |
| List course(s) for college credit only: | List course(s) for dual credit: | |
| High
School verification: I certify that this student is eligible
to enroll in the Dual Enrollment Program.
Signed: _______________________________________________ Date: ________________ Books will be paid for by the local high school: q Yes q No |
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Section III: To be completed by Montcalm Community College
| Contact
person:
Deb Alexander, Director of Admissions |
Phone:
(989) 328-1276 |