Fillable 2017-18 POSTSECONDARY ENROLLMENT OPTIONS Student Name (Last, First, (St Cloud Technical and Community College)

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2017-18 POSTSECONDARY ENROLLMENT OPTIONS Student Name (Last, First, (St Cloud Technical and Community College)

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Division of School Finance
1500 Highway 36 West
Roseville, MN 55113-4266
POSTSECONDARY ENROLLMENT OPTIONS
PROGRAM NOTICE OF STUDENT
REGISTRATION
ED-01763-18
NOTE: Complete an enrollment form for each instructional term and postsecondary institution the student attends. Once Sections 1
and 2 are completely filled out, mail the enrollment form to the postsecondary institution. Do not mail this form to MDE.
College Student ID Number:
1. TO BE COMPLETED AND SIGNED BY THE STUDENT & PARENT/GUARDIAN
Student Name (Last, First, M.I.) Select Gender M F Date of Birth (MM/DD/YYYY)
Postsecondary Institution This Term: Parent/Guardian Name: Address (if different than above)
Street Address:
City:
Zip Code:
Telephone Number:
Minnesota Statutes, section 124D.09, subd. 6,requires students and parent/guardian sign a statement indicating they have received
information about the program, are aware counseling services are available and understand the responsibilities regarding enrollment in
postsecondary courses. We have received the information required under Minnesota Statutes, section 124D.09, and are aware the
student above is enrolling in postsecondary courses.
___________________________________________________________________________________________________________
Student Signature Parent/Guardian Signature (if student is under 18) Date
Upon completion of Section 1, pass this form to the pupil’s secondary school for completion of Section 2
2. TO BE COMPLETED BY SECONDARY/NON-PUBLIC/HOME SCHOOL
Secondary/Non-Public/Home School Name
School Type – Select One
Public or Non-Public or Home School
Student’s MARSS Number
Attending School District Name
Attending School District #
Resident District Name
Resident District #
Student’s grade while attending this Postsecondary Institution Grade 10 Grade 11 Grade 12
Select grade level Public only
NOTE: HIGH SCHOOL GRADUATES AND 21 YEAR OLDS ARE NOT ELIGIBLE
___________________________________________________________________________________________________________
Students may not enroll in PSEO courses in addition to a full high school class load. Does this student have at least one free class
period during the high school day? (select one) Yes No
Is the above student eligible for program application? (See page 3 for requirements) (select one) Yes No
SECONDARY/NON-PUBLIC/HOME SCHOOL VERIFICATION
I certify the student identified in Section 1 meets the eligibility requirements outlined in Minnesota Statutes, section. 124D.09, to apply
for participation in the Postsecondary Enrollment Options (PSEO) program this term, and the information in Section 2 is accurate and
applicable to the student.
Secondary School Contact Name Contact Signature Email Address Telephone Date
___________________________________________________________________________________________________________
Directions: Upon completion of Section 2, pass this form to the postsecondary institution for completion of Section 3.
2017-18
POSTSECONDARY ENROLLMENT OPTIONS NOTICE OF STUDENT REGISTRATION ED‐01763‐18
2
Student Name (Last, First, M.I.) Date of Birth (MM/DD/YYYY) College Student ID Number
3. TO BE COMPLETED BY THE POSTSECONDARY INSITUTION
Name of Postsecondary Institution Postsecondary Institution Number City of Postsecondary Institution
Term of planned attendance Semester 1 Semester 2 Qtr. 1 Qtr.2 Qtr.3
Select one
___________________________________________________________________________________________________________
Postsecondary Institution Contact Name Email address Telephone
COURSE NUMBER
COURSE CREDITS
COURSES TAKEN FOR SECONDARY CREDIT
Course #1
Cour
s
e # 2
Course # 3
Course #4
Course #5
Course #6
I certify the student identified in Section 1 is registered this term for the courses indicated above, all courses are non-sectarian in
content, are not remedial or developmental, and the student has indicated to me the courses are to be taken for secondary credit.
__________________________________ ___ ___________
Signature-Postsecondary Institution Contact Person
___________________________________________________________
Title Date
REQUIRED UNDER MINNESOTA STATUTE, SECTION 124D.09, SUBD. 5
“If an institution accepts a secondary pupil for enrollment under this section, the institution shall send written notice to the pupil, the
pupil’s school or school district, and the commissioner within ten days of acceptance. The notice must indicate the course and hours of
enrollment of that pupil.”
The postsecondary institution must mail a copy of this form, within ten days of acceptance, to the following address: Minnesota
Department of Education, Division of School Finance, 1500 Highway 36 West, Roseville, MN, 55113.
Additionally, copies of the completed form must be sent, within ten days of acceptance, to the student
indicated in Section 1 and the secondary school of attendance indicated in Section 2
.
2017-18
POSTSECONDARY ENROLLMENT OPTIONS NOTICE OF STUDENT REGISTRATION ED‐01763‐18
3
POSTSECONDARY ENROLLMENT OPTIONS PROGRAM
STUDENT ELIGIBILITY - Minnesota Statutes, section 124D.68 and section
124D.09
An 11
th
or 12 grade pupil enrolled in a Minnesota public, nonpublic, home school or American Indian-controlled
tribal contract or grant school eligible for aid under section 124D.83, except a foreign exchange pupil enrolled
in a district under a cultural exchange program,
may apply to an eligible institution to enroll in nonsectarian
courses offered by that postsecondary institution.
A 9
th
or 10
th
grade pupil enrolled in a district or an American Indian-controlled tribal contract or grant school eligible
for aid under section 124D.83, except a foreign exchange pupil enrolled in a district under a cultural exchange
program, may apply to enroll in nonsectarian courses offered under 124D.83, subd. 10 courses according to
agreements, if
The school district and the eligible postsecondary institution providing the course agree to the student’s
enrollment or
(2) The course is a world language course currently available to 11
th
and 12
th
grade students, and consistent with
section 120B.022 governing world language standards, certificates, and seals.
(1)
Career and Technical Education (CTE) courses offered by a Minnesota state college or university
A 10
th
, 11
th
, or 12
th
grade pupil enrolled in a district or an American Indian-controlled tribal contract or grant
school eligible for aid under section 124D.83, except a foreign exchange pupil enrolled in a district under a
cultural exchange program, may enroll in a career or technical education course offered by a Minnesota state
college or university. A 10
th
grade pupil applying for enrollment in a career or technical education course must
have received a passing score on the 8
th
grade Minnesota Comprehensive Assessment (MCA) in reading as a
condition of enrollment. A current 10
th
grade pupil who did not take the 8
th
grade MCA in reading may
substitute another reading assessment accepted by the enrolling postsecondary institution
A.
Limit on Participation:
1)
A pupil who first enrolls in grade 9 may not enroll in postsecondary courses for more than the
equivalent of four academic years.
2)
A pupil who first enrolls in grade 10 may not enroll in postsecondary courses for more than the
equivalent of three academic years.
3)
A pupil who first enrolls in grade 11 may not enroll in postsecondary courses for more than the
equivalent of two academic years.
4)
A pupil who first enrolls in grade 12 may not enroll in postsecondary courses for more than the
equivalent of one academic year.
5)
If a pupil in grade 9, 10, 11, or 12 first enrolls in a postsecondary course for secondary credit during
the school year, the time of participation shall be reduced proportionately.
B.
For purposes of determining PSEO eligibility:
1)
2)
An academic year is equivalent to a school year. A school year is defined as July 1 through June 30.
If a pupil is in a learning year or other year-round program and begins each grade in the summer
session, summer sessions shall not be counted against the time of participation.
3)
If a district determines a pupil is not on track to graduate, the limit on participation does not apply to
that pupil
4)
A pupil who has graduated from high school cannot participate in a program under this section.
5)
A pupil who has completed course requirements for graduation but who has not received a diploma
may participate in the program.
C.
An institution shall not enroll secondary pupils, for postsecondary enrollment options purposes, in
sectarian, remedial, developmental, or other courses that are not college level unless the student is an
alternative education student participating in an approved full-time early/middle college program designed
with a well-defined pathway to allow the student to earn a certificate or degree.
D.
All textbooks and equipment provided to a pupil, and paid for under Minnesota
Statute, section 124D.09,
Subdivision 13, are the property of the pupil’s postsecondary institution. Each pupil is required to return all
textbooks and equipment to the postsecondary institution after the course has ended.
For more information on the program and requirements, view the Postsecondary Enrollment Options School
Finance webpage at MDE > Districts, Schools and Educators > School Finance > Postsecondary
Enrollment Options.
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2017-18 POSTSECONDARY ENROLLMENT OPTIONS Student Name (Last, First, (St Cloud Technical and Community College)

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Completed 26 July 2020

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