Fillable Annual Dual Credit and Concurrent Enrollment Approval Form (South Plains College)

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Annual Dual Credit and Concurrent Enrollment Approval Form (South Plains College)

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The Annual Dual Credit and Concurrent Enrollment Approval Form (South Plains College) form is 1 page long and contains:

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  • 11 check-boxes
  • 26 other fields

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File type: PDF

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Annual Dual Credit and Concurrent Enrollment Approval Form
(Use blue or black ink only)
Student Name: _________________________________________________ Date of Birth: ___________________________________________
SPC Student ID/Last Four Digits of Social Security Number: ______________ Phone: _______________________________________________
High School Attending: ___________________________________________ Email Address: _________________________________________
Grade Level: Freshman Sophomore Junior Senior
Pathway: STEM Business & Industry Public Service Arts & Humanities Multi-Disciplinary Studies
Fall Semester — Please list the course(s) you wish to enroll in using SPC course numbers, title and rubric.
SPC Course Number & Section*
SPC Course Title
Instructor *
Example: ENGL 1302.098
Example: Composition II
Example: Staff
CTE Dual Credit courses will be included on the spring approval form.
*The course section number and Instructor should only be listed for courses being taught through ITV or at a high school location.
The Course Section number and Instructor should not be included for online courses.
Will you be concurrently enrolled at another college/university while attending SPC, this fall? ☐ Yes ☐ No
If yes, name of institution: ________________________________________________________________________________
(Upon completion of concurrent enrollment course(s), I understand that I must provide South Plains College with an official
college transcript or letter of good standing.)
“I understand that by enrolling in a dual credit course or the early admission program, that this is a college level course; therefore, will adhere to all
policies of the college. I understand that I am not officially enrolled unless all required registration documents and course payment have been submitted
to the college. I further understand that if for any reason I must withdraw from a course I will notify my high school counselor and submit a drop request
to the Admissions and Records Office at South Plains College. I hereby give permission for SPC to release my educational record (including but not
limited to final grades, account activity and discipline) to my principal and/or counselor in accordance with the Family Education Rights and Privacy
Act (FERPA).”
____________________________ __________ ______________________________ ___________
Student Signature Date Parent Signature Date
__________________________________________ ______________________________ ___________
High School Principal (Print Name) Signature Date
*The student’s social security number (SSN) is being requested because it is a unique identification number which is maintained for the purpose of assurance that the correct student record
is accessed. The disclosure of such information is voluntary. The disclosure of the social security number will be governed by the Public Information Act (Charter 552 of the Texas
Government Code).
Please return completed form to:
SPC – Dual Credit Office, Box 6
1401 S. College Avenue
Levelland TX 79336
Dual Credit 4.2020
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Dual Credit FERPA Notice
Student Records
South Plains College is bound by the Texas Open Records Law, the Family Educational Rights and Privacy Act of 1974, and institutional
procedures in determining access to or the release of student records.
Student records are maintained by the following areas.
1. Academic Records: Admissions and Records Office, Dual Credit Office, Department and Faculty Offices, Advising and Testing
Office, and Scholarship Office
2. Student Affairs Records: Dean of Students Office and Counseling Center
3. Financial Records: Business Office, Financial Aid Office and Special Services Office
A student’s educational record normally consists of the following academic information: transcript of courses taken, grades earned,
semester grade point average, cumulative grade point average, placement test scores information, admissions application, transcript and
certificate evaluations, and tuition classification information.
Rights under the Family Educational Rights and Privacy Act
The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their educational records. These
rights include the following.
1.) The right to inspect and review the student’s educational records within 45 days from the day the college receives a request for
access. Students should submit to the Registrar, dean, departmental chairperson or other appropriate official, written requests
that identify the record(s) they wish to inspect. The college official will make arrangements for access and notify the student of the
time and place where the records may be inspected. If the records are not maintained by the college official to whom the request
was submitted, that official shall advise the student of the correct official to whom the request should be addressed.
2.) The right to request the amendment of the student’s educational records that the student believes are inaccurate or misleading.
Students may ask the college to amend a record that is believed to be inaccurate or misleading. The student should write the
college official responsible for the record, clearly identify the part of the record to be changed, and specify why it's inaccurate or
misleading. If the college decides not to amend the record as requested by the student, the college will notify the student of the
decision and advise the student of his or her right to a hearing regarding the request for amendment. Additional information
regarding the hearing procedures will be provided to the student when notified of the right to a hearing.
3.) The right to consent to disclosures of personally identifiable information contained in the student’s educational record except to
the extent that FERPA authorizes disclosure without consent. Exceptions which permit disclosure without consent include
disclosure to school officials or individuals with legitimate educational interests. These individuals may include a person employed
by South Plains College in an administrative, supervisory, academic or research, or support staff position (including law
enforcement unit personnel and health staff); a person or company with whom the college has contracted (such as an attorney,
auditor, or collection agent); a person serving on the Board of Regents; or a student serving on an official committee (such as a
disciplinary or grievance committee) or assisting another school official in performing his or her tasks. A school official has a
legitimate educational interest if the official needs to review an educational record in order to fulfill his or her professional
responsibility. Upon request, South Plains College discloses educational records without consent to officials of another school in
which a student seeks or intends to enroll.
4.) The right to file a complaint with the U.S. Department of Education concerning alleged failures by South Plains College to comply
with the requirements of FERPA. The name and address of the office that administers FERPA is: Family Policy Compliance Office,
U.S. Department of Education, 600 Independence Ave. SW, Washington, DC 20202-4605.
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Annual Dual Credit and Concurrent Enrollment Approval Form (South Plains College)

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Completed 27 July 2020

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