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Texas Woman’s University
Dual Credit Permission Form
For Concurrent/Dual Credit Enrollment
2019-2020 Academic Year
P.O. Box 425649,%Denton ,%T X %7 6 2 0 4 -5589 940-898-3076% (local) or 1-866-809-6130% (toll free) OAP@twu.edu
This completed appl
ication is to be submitted to the TWU Office of Admissions Processing with your official high% school transcript.
NAME AND& ADDRESS INFORMATION
Social Security Number:_____-___-_____ Date of Birth (month/day/year):___/___/____
Full, Legal Name:_________________________________________________________________
Gender:_____Male _____Female Place of Birth:_____________________________
Address:______________________________________ Apt #______% City:__________________
County:_______________% State:_______% ZIP: _____________% Country: ______________________
Home phone: _____________ Cell phone: _____________Email: ___________________________
Emergency contact: ________________________________% Relationship: ____________________
Phone: __________________% Email:__________________________________________________
Are you% a New or Returning TWU Dual Credit Student? New Returning
Educational& Data (a& new signature/permiss io n &form must be& submitted& for each& academic& year)
High School (name, city and state): _________________________________________
Overall GPA:%_____ _ _ _ %Curr e n t %Grade :_ _ _ _ _ _
List exact titles of courses you intend to complete during con current/du al credit en rollmen t and the number of credits
you will earn for each. You& must circle &the &term(s) in &w hich &you &plan &to &ta k e &the &cour se .
Course name: ______________________ Credit hrs: __________ Fall Spring Summ er
Course name: ______________________% Credit hrs: __________ Fall Spring Summ er
Course name: ______________________ Credit hrs: __________ Fall Spring Summ er
Course name: ______________________ Credit hrs: __________ Fall Spring Summ er
Course name: ______________________% credit hrs: __________ Fall Spring Summer
*Continued enrollment for students earning/ a D or F/ in dual/ credit courses may require
additional/ review and/ approval/ by/ a school/ or university official.*
Required for all applicants:& Failure to com plete, sign and date this portion will result in yo ur application review being& delayed.
I%certify %that %the %informa tio n %I%h av e %p ro v id ed is %complete %and %correct %to %the %best %of %my %k no wledge. If %my %application is %accepted, I agree% to abide% by% the%
policies, rules and% regulations at Texas Woman’s University.% I authorize the University to verify the information I have provided.% I furth e r% und e rstan d that%
the information submitted herein will be relied upon by the officials of% the University in determining my admissions and residence status for% tuition
purposes and% that the submission% of false information% is grounds for rejection% of my application, withdrawal of acceptance, cancellation of enrollment
and/or disciplinary action. Pursuant to my rights under the Family Educational Rights and% Privacy Act (FERPA), I consent to% have my TWU% academic record%
released to the high school% for% the purpose of% ap ply ing the credit(s)% and grade(s).% I furth er% conse nt% to authorize the release of my% TWU academic% record to
my parent(s) or legal guardian(s).
Student’s Signature: __________________________________________% _______ Date:
_____________________________
Parent/guardian approval
This student is responsible for the payment of all tuition, fees and books, and for% providing his/her% own transportation (if% applicable) to the courses listed
in %the %above %section.%%We %u n de rsta n d %th a t %the %st ud e n t %mu st %a bid e %b y %th e %University rules and% regulations, and% that course grades will be reported% to% the
respective high s cho ol%
for dual enrollment purposes and% reporting.
Parent/guardian signature:
______________________________________________ Date: ____________________________
Parent/guardian printed n
ame: ___________________________________________ Date: ____________________________
School district approval
The above mentioned student currently maintains at least a% 2.0 GPA and demonstrates the responsibilities necessary for enrollment %into %the %listed %course(s).%%
By signing, I certify this student is approved% to% take the course(s) listed% above and% meets any and% all prerequisites for acceptance into% this course(s).
Does this student currently qualify for the Federal FREE Lunch Program?% YES NO
Principal/counselor’s printed name and% title:______________________________________________________________________
Principal/counselor’s signature: _________________________________________________Date: ___________________________
