PROGRAM APPROVAL FORM
(All fields must be completed and form submitted prior to acceptance.)
Part 1: Student Information
Student Name__________________________________________________________________ Entrance Term/Year_______________
Name of High School________________________________________________________________________________________________
Student Date of Birth__________________ Grade Level___________________ Expected Date of H.S. Graduation ____________________
Part 2: Dual Enrollment Criteria
• Student must meet admissions requirements established by Gadsden State for dual enrollment.
• Student must have a minimum cumulative/unweighted high school grade point average of 2.5 on a 4.0 scale.
• Student must have written approval of the two designated parties indicated at the bottom of this form.
• Student must be in grades 10, 11, or 12 or have an exception granted.
• Student must take a state-approved college placement test prior to registering for dual enrollment courses for the 12th grade year.
• Student must take a state-approved college placement test, where minimum placement is required.
Part 3: Student Acknowledgement
• Dual students who withdraw or earn less than a grade of “C” in a GSCC course will be suspended for a minimum of one semester. The
one-semester suspension may not be served during the summer term, and the student must reapply to the program before reentry.
• Student must make payment or have verified scholarship funds for tuition and fees by the established deadlines or risk automatic drop
• Seniors must complete all dual credit courses before graduation.
• Students with disabilities who may require special accommodations must file the appropriate documentation with the Disability
Compliance Officer before accommodations may be made.
• Dual Enrollment for Dual Credit courses offered by the postsecondary institution will be of postsecondary/college level. Course
curricula and subject matter will not be modified.
• Students must adhere to all institutional policies and requirements including, but not limited to, those outlined in course syllabi, the
academic calendar, the college catalog, and the Student Code of Conduct. The institution reserves the right to refuse re-admission to
any student who violates institutional policies.
• Earned course credit completed at Gadsden State Community College will appear on an official transcript only after dually-enrolled
student has graduated from high school and an official high school transcript has been received. Courses may not be audited.
• Student must advise parent or legal guardian of participation in the dual enrollment program at Gadsden State Community College.
*Signature of Student_________________________________________________________ Date______________________
*By signing, I acknowledge and understand all of the above, and I hereby authorize GSCC to release my academic and student related information to attending high school
personnel. I understand that I am subject to the Federal Education Rights and Privacy Act of 1974 (FERPA), as outlined in the GSCC Catalog and Student Handbook.
Principal or Career/Technical Program Director Signature
Admissions Office | P.O. Box 227 Gadsden, Al. 35902-0227 | (256) 439-6910 | Fax (256) 549-8466 | firstname.lastname@example.org 02/2018
Criteria Verification and Approval
To be completed by High School Administrator(s)
Student meets GPA requirement.
GPA on 4.0 Scale (unweighted): ______________________
Student demonstrates both academic readiness and social maturity.
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