Rev. 05/2020
Admissions & Advising Center
Admissions & Advising Center,Piedmont Virginia Community College, 501 College Drive, Charlottesville, VA 22902
Phone 434.961.6581, Fax 434.961.5251
Dual Credit Student Permission Form
(High school guidance director/principal/parent-please forward completed form to admissions@pvcc.edu)
Student Name:
Social Security #:
Type of Student:
High School Student
(requires high school principal/guidance director
approval and parent approval below)
Home School Student
(requires parent approval below)
Course Selection(s):
Date:
Date:
Parent’s Signature:
XXX-XX-
Your child has indicated an interes
t in taking the course(s) above at Piedmont Virginia Community
College.
I give my
approval of my child’s enrollment at PVCC. (If your child is a home school student,
your signature below also indicates that you have received approval for intent to home school.)
The student above has indicated
an interest in taking the course(s) above at Piedmont Virginia
Community College. I give my approval of the student’s enrollment at PVCC based on the
student’s motivation, interest, maturity, ability to benefit or standardized test scores, and parental
approval.
Parent’s Name (Printed):
Principal/Guidance Director's Name (Printed):
Signature of Principal/Guidance Director:
Name of High School:
will not count towards high school graduation.
will not count towards high school graduation.
will not count towards high school graduation.
will not count towards high school graduation.
will not count towards high school graduation.
click to sign
signature
click to edit
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click to sign
signature
click to edit
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