Course Approval AND Parent Consent and Waiver for Dual Enrollment

Please fill out this form with the student's contact information and preferences. To be completed by Parent or Legal Guardian.

Student Information

First Name

Middle Name

Last Name

Birthdate

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Current School or Home School Association

Current Grade Level

High School Graduation Date (MM/YYYY)

I understand that if I am admitted under this program, that a college level standard of conduct is required. It is my responsibility to comply with the admissions policies, student code of conduct and academic standards of Lycoming College, and the standards set forth in the course syllabus. I understand that enrolling in certain courses could negatively affect my future enrollment, scholarships, financial aid, tuition costs. I also understand that academic information such as test scores and college transcripts will be provided by Lycoming College to my corresponding high school.

Parent Digital Signature

Parent Phone Number

To be completed by the Parent or Legal Guardian

I understand the student may be exposed to mature or sensitive topics in the classroom and open laboratories, including libraries, learning centers and computer labs.

Yes

No

I understand that students who receive a letter grade of a D or F in a dual credit course are not permitted to continue in the dual credit program.

Yes

No

I understand that once the student is registered in a college course, he/she controls access to his or her educational records under the Family Educational Rights and Privacy Act (FERPA) and - unless an exception applies - I may not have access to my student's records without his/her written permission or proof that I claimed the student as a dependent on my most recent income tax return.

Yes

No

I understand it is the students responsibility to ensure the college course selected does not conflict with required high school class schedule.

Yes

No

My digital signature below acknowledges that I have read and understand the policies above.

Date of signature