___________ ________ ________________________________________________
Date Semester High School Name
______________________________ ______________ ____________________________
Name/Title Phone Email address
_____________________________________________ __________________________________________
High School representative Date LDCC representative Date
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DUAL ENROLLMENT COURSE REQUEST
This document must be completed and signed by LDCC before any action is taken.
Submit request to Lyndsey Best at Lyndseybest@ladelta.edu or by fax - 318-345-9002
Course Request: (Use separate sheet if needed)
Course
Name
HS Instructor Name*
Day & Time of
Class
Number
of
Students
Place check in column if applicable
Instructor to be
provided by LDCC
(minimum of 15 students )
Online Course
Delivery
*All instructors must be approved by LA Delta Community College (LDCC)
prior to the beginning of the semester.
Prospective in
structors will:
• Submit unofficial transcripts and contact information form immediately
• Complete an online application for employment at Delta Community College Employment Application
• Provide official transcripts to support Master’s Degree + 18 in subject; Request e-script delivery to
lyndseybest@ladelta.edu
or the appropriate division dean or by mail to Human Resources at 7500 Millhaven Rd.,
Monroe, LA 71203 (graduate degree not required for remedial and some technical courses)
• Provide proof of credential or certification for technical courses.
• Submit and obtain approval of instructor’s syllabus or revise the syllabus to meet Delta’s requirements
• Provide additional information requested by LDCC, including HR employment packet.
Course Requested Course Approved
