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
____ FASC – incl assoc dean
____ Notify DC dir & assoc dean
