Request for Admission Students Under the Age of 18 form - glendale ...

To be Completed by the Student: q Fall q Spring q Sum I q Sum II
Year
Student Name
Age
Student Identification Number/Social Security Number
Home Address
SAIS (Student Accountability Information System) Number
City, State, Zip
( )
Home Phone #
Name of School Attending Grade Expected Graduation (mo./yr.)
Course Number Section Number Title Credits
Total Credit Hours
I agree to the exchange of academic information between the participating institutions, including but not limited
to college grade reports, transcripts, and any other pertinent documents. I give permission to release any and all
Glendale Community College information to my parents and/or legal guardian.
Signature of Student
Date
To be Completed by the High School/Junior High School District Official:
I recommend the student named on this form for Admission - Students Under the Age of 18 to Glendale Community
College for the semester, 20 . I believe the student will profit from concurrent
enrollment. It is also understood that the student will receive college credit for successfully completed course
work. The student has a cumulative grade point average (G.P.A.) of on a system with
a class rank of / . Will high school / junior high school credit be granted q Yes q No
Signature of High School / Junior High School Counselor / Administrator
Date
To be Completed by the Parent or Guardian:
I give permission for
to enroll as a student at Glendale Community College
during the semester, 20 . I understand that although he/she is under 18, he/she is entering an
adult environment. As a college student, I understand that my son/daughter:
___Will be establishing a college academic record and will be required to report enrollment at GCC to future
colleges or universities.
___ Will be responsible for knowing and following college policies published in the General Catalog & Student
Handbook and Schedule of Classes.
___Will be subject to the course requirements, grading standards and attendance requirements established by
the instructor in the course syllabus.
___May, at times, come in contact with course subject matter of a mature and sensitive nature.
___May be using unfiltered computer systems, common to a college environment.
___Will be protected under the Federal Education Rights and Privacy Act and information about academic
performance, attendance and educational records cannot be shared with a "parent" as defined by FERPA
without the students written permission, or documented evidence that the student is a dependant according to
the Internal Revenue Code of 1986, section 152.
Signature of Parent / Guardian
Date
For additional information call at 623.845.3313.
11/01/07