Application For High School Concurrent Enrollment - Tulsa Community College
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APPLICATION FOR HIGH SCHOOL
CONCURRENT ENROLLMENT
Revised 4-17-15 MC/ES
Name: __________________________________________________ DOB:____________________ CWID: T_____________________
Address: ______________________________________________________________________________________________________
Phone: (_____) ______-_______ Email: _____________________@______________
City
State
Zip
Grade: □ Junior □ Senior
Graduation Date (Month and Year) _________________
LIST TCC COURSES BELOW:
CRN
Discipline
Course #
Section
Title
Credit Hours
Student & Parent or Guardian Responsibility
See Reverse Side For Policy Guidelines and Instructions.
We have read and understand the policy guidelines for concurrent enrollment on the back of this application. Any addition to the TCC course
schedule listed above must be approved by the Director of Enrollment Services or designee.
We understand that any schedule adjustment or withdraw must be approved by the High School Counselor. Failure to withdraw may result in an
“F” grade that cannot be removed. (Student must complete the Concurrent Schedule Adjustment Form which is available online.)
If the student plans to enroll at TCC next semester, another concurrent application must be completed and submitted to the Enrollment Services
office.
I give my permission for Tulsa Community College to share information with my high school regarding attendance, grades, academic performance,
disciplinary actions, and my student records.
Parent/Guardian Signature: _________________________________________________________________________Date: _______________
Student Signature: _________________________________________________________________________________Date: _______________
Student should personally return the form, transcript, and ACT scores to any Enrollment Services Office.
TO BE COMPLETED BY HIGH SCHOOL PRINCIPAL AND COUNSELOR:
List all classes on high school class schedule. Schedule not applicable for Summer.
□
□
□
Name of High School:___________________________________________
Semester:
(Check Only One)
Fall
Spring
Summer Year: ________
Counselor Name: __________________________________
Phone:__________________ Email: __________________________________________________
We have examined the academic records of the student above and certify that he/she is eligible to satisfy high school curricular and graduation
TITLE
HIGH SCHOOL
CREDIT HOURS
UNIT
1.
3
2.
3
3.
3
4.
3
5.
3
requirements no later than the spring semester of the senior year.
I recommend that the student be permitted to enroll for the semester indicated above, subject to the guidelines for concurrent enrollment on the
reverse side of this form.
Principal Signature:______________________________ Counselor Signature:_______________________________________
TO BE COMPLETED BY ENROLLMENT SERVICES:
Semester/Year:______________
Grade: □ Junior □ Senior
Graduation Year:_________
GPA_________
ACT: E ____ M____ R____ SR ____ COMP ____
High School transcript received within the current school year? □ Yes □ No
# of enrolled H.S. hours: ______ # hours at TCC: ______ Total # of hours: ______
(not to exceed 19 in Fall/Spring and 9 Summer)
Waiver: □ Yes □ No
Comments: ________________________________________________________________________________________________________
Enrollment Staff Signature:_________________________________________________________ Date:_____________ Reviewed by: __________________________
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