Fillable DUAL ENROLLMENT COURSE REQUEST (J Sargeant Reynolds Community College)

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DUAL ENROLLMENT COURSE REQUEST (J Sargeant Reynolds Community College)

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Students complete this form with your Parent (s) or Legal Guardian(s), and submit it to your High School Counselor.
DUAL ENROLLMENT COURSE REQUEST
Name of High School: Grade:
Requested Courses Location Term
Class
Subject
Catalog
Number
Section
Number
Class ID
Number
Class Title H. S.
Site
JSRCC Fall
20___
Spring
20___
JSRCC Form No. 11-0025 Dual-Enrollment Course Request form 03-2017
Student’s SSN: JSR Student ID: (If known)
SIGNATURE OF STUDENT: DATE:
Last Name First Name Full Middle Jr.,3rd
Readiness Standard Met: VPT Compass Asset PSAT SAT ACT SOL .
After Readiness Standard is met, depending upon the course, placement test may be required. Placement test may be waived
with minimum scores of: SAT - Reading/Writing 480, Math 530 (and must satisfy pre-requisite courses), or ACT—English 18 & Reading
18, Math 22 and (and must satisfy pre-requisite courses). PSAT—Reading/Writing 390, Math 500
Please submit official documentation and/or copy of the test scores with this form as appropriate.
This student has the approval of our high school to enroll in Dual Enrollment classes and will receive credit toward high school
graduation upon successful completion of each class. This student wishes to take the listed classes at the campus(es) desig-
nated above. He or she has met the minimum prerequisites as outlined in the JSRCC College Catalog.
SIGNATURE OF SCHOOL COUNSELOR: DATE:
FOR JSRCC OFFICE USE:
App on File: YES NO Residency: IS OS Term Admitted:
Readiness Met: YES NO
Placement Test Waived: YES NO
This institution promotes and maintains educational opportunities without regard to race, color, sex, ethnicity, religion, gender, age (except when age is a bona fide occupational
qualification) handicap, national origin or other non-merit factors. Employer, date of birth, social security, sex and race information are optional and used for research, reporting and
management of student records.
HIGH SCHOOL COUNSELOR COMPLETES THIS SECTION
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DUAL ENROLLMENT COURSE REQUEST (J Sargeant Reynolds Community College)

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Completed 27 July 2020

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