For A&R Office Use Only: Initial: ______ Date: ______ Fee Rate Applies: CCAP Non-CCAP
VC A&R 13/19/20
On Base Doc Type: Special Admission Form
Please read and acknowledge the following by your signature:
1. Dual Enrollment/Special Admission students are expected to abide by all college rules and standards of conduct. It is the student’s responsibility to know these rules. We
strongly recommend you review the following with your student:
The college catalog regarding: student conduct, student grievance, student health services, sexual harassment, and sexual assault.
The college catalog and schedule of classes regarding: requirements for admission, the procedures for adding and dropping classes, the registration calendar and the
Important Deadlines” calendar for drop and withdrawal deadlines.
Students are responsible to drop classes. All course adjustments must be done in person at the Admissions & Records Office by the set deadline. Visit
for deadlines. Failure to drop a class by the deadline can result in an “F” grade on your student’s
permanent record.
The potential for course content to be outside of the normal parameters your young student has been exposed to in the K-12 setting.
2. Although the colleges of the VCCCD are considered to be safe campuses, there have been incidences on and around the campuses that warrant particular caution where
the presence of minors is concerned. In accordance with federal “Right to Know” legislation, crime statistics are available from the Campus Police Office. The college is
generally considered an adult environment, and does not provide special monitoring of minor students on campus. We strongly recommend the following:
Make sure your child always has a way to contact you. Classes can be cancelled on very short notice.
Be sure to pre-arrange a pick-up location in case of any emergencies.
3. Courses taken at a college are intended to supplement the course work your student is taking at the home campus, not to replace it. Students admitted to a college are
expected to take classes that are not available at their home campus. Courses must be stated and approved on the “Recommendation for Special Admission” form.
4. The coursework your child completes will be awarded college credit. It is a permanent record and is subject to all standards of scholarship observed by the college. The
courses taken at the college may also be used by your student’s “home” campus at that school’s discretion. You and your child should confer with a counselor at the
home campus for more information.
5. The coursework your child completes is subject to the same standards of progress that apply to mainstream students. College policies governing academic progress,
probation and dismissal are found in the college catalog.
6. College courses are designed for adult college students. The content of the course may include adult materials, and discussions may include adult subject matter. Course
content will not be altered because a minor is present in the classroom. Some courses may include physical requirements.
7. Right of access to student records: In compliance with the Federal Educational Rights and Privacy Act (Buckley Amendment), once a student of any age enters a post-
secondary educational institution, the student assumes rights and responsibilities previously conferred upon the parent. Translation: your child must complete and sign
the application for admission and registration forms, and is responsible for requesting copies of his/her transcript. Student attendance and progress may not be discussed
with the parent unless the student is present or has given written permission.
8. Parent Authorization to Consent to Medical Treatment or Personal Counseling of Minors. I give my permission for emergency
First aid and treatment for my minor child/legal ward. I also give my permission for him/her to be treated by a nurse, nurse practitioner, physician and/or personal
counseling in the Student Health Center at the colleges of Ventura County Community College District (Moorpark/Oxnard/Ventura Colleges).
By signing below, I certify I have read and understand this petition for Dual Enrollment/Special Admission and the related Memorandum of Understanding. Further, I give
permission to VCCCD to share information related to my academic progress with my school and/or school district under a CCAP agreement. I hereby request permission
to enroll in the community college classes recommended above.
___________________________________________________________ _________________________
y signing below, I certify I have read and understand this petition for Dual Enrollment/Special Admission and the related Memorandum of Understanding. Further, I
understand my student is giving permission to share their information as detailed above. I hereby request my student be allowed to enroll in the community college
courses recommended above.
___________________________________________________________ _________________________
Signature of Student
Signature of Parent or Guardian
Recommendation for Dual Enrollment (Special [K-12] Admission)
This form is required each semester the student participates
Student Name:
College ID: 900
Address: __________________________________________ Phone: ________________ Birth Date: _____________
Present Grade: _______ GPA: _______ School Name: _________________________________________________
(Courses must be listed by school official students with blank spaces will not be registered at the college)
____________________________________________ ____________________________________________
__________________________ ____________________________________________
I certify the information contained in this petition is valid and the student has demonstrated the ability to benefit from advanced scholastic or vocational
education offered by the college. This recommendation for Dual Enrollment/Special Admission is approved in compliance with CA Ed. Code sections 76000 and
48800 et seq.
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Principal or Designee (Print)
Official School Email
Signature of Principal or Designee
click to sign
click to edit