DUAL CREDIT COURSE APPLICATION
100 Col
lege Drive ● Kankakee, IL 60901-6505 ● 815-802-8816 ● FAX: 815-802-8101
ONE FORM PER COURSE, PLEASE.
Submit this form t
o KCC no later than May 30 prior to the upcoming school year for both fall and spring
semesters for dual credit courses.
Today’s date: _____________________________
High school: _________________________________________________________________
High school instructor: _________________________________________________________
Phone number: ___________________________
Instructor’s high school email: ___________________________________________________
KCC course number and/or name: _______________________________________________
Requesting for school year __________________
Semester(s) to offer dual credit course? Fall Spring
How many sections will you offer per semester? (choose one) 1 2 3
Attach a copy of the dual credit course syllabus.
If a new instructor, attach a copy of post-secondary transcripts to verify teaching credentials. Transcripts do
not have to be sent if they are on file at KCC.
I agree to abide by the KCC policies and procedures related to teaching courses articulated in the Dual Credit
Manual, including grading standards and course outcomes. I understand that no compensation will be provided
to me by KCC for any services in the Dual-Credit Program.
Instructor Signature: ________________________________________________________
Date:
______________________________
_____________________________________
Off
ice use only
Prefix/No. Sect:
Semester(s)
Colleague Processes
__________________
__________________
____ SECT
____ XIDC
__________________
__________________
____ FASC incl assoc dean
____ XSDT
__________________
__________________
____ ASCI
____ Notify DC dir & assoc dean
(xxx) xxx-xxxx
mm-dd-yyyy
3/2017
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