Dual Enrollment Instructor_______________________________________________________________
Home Phone Numb
er________________________ Cell Phone Number_______________________
Personal Ema
il______________________________ Delta Email______________________________
School Name_______________________________ City ___________________________________
Principal or
Counselor________________________ Phone Number __________________________
PROPOSED DUAL ENROLLMENT SCHEDULE
Louisiana Purchase Building, 359
INSTRUCTOR VERIFICATION (Completed by Division Chair)
SALARY,
CREDENTIALED
DATE
CREDENDTIALED
SYLLABUS
ON FILE
Textbook
Adopted
Credit Hours
Assigned
TEXTBOOK__
_______________________________________________________ EDITION______________________
PUBLISHER___________________________________________________ ISBN_______________________________
CURRENT SY
LLABUS PROVIDED______ YES ______NO
Recommended by one
or other:
______________________
____________ ______________________________________
Dual Enrollment Coordinator Date Campus Director Date
*Reason for disapproval: ___________________________________________________________________________
This form will be distributed to all appropriate parties immediately upon its approval or disapproval.
Signatures: Date Approved Disapproved*
DUAL ENROLLMENT COURSE APPROVAL FORM
(approved as of Fall 2016)
This document must be completed and signed by the
Division Chair and Dean before any action is taken.
Term:
