@ CENTRAL GEORGIA TECHNICAL COLLEGE
Dual Enrollment Charges Acknowledgment Form
Student First and Last Name: ________________________________________________________________________________________
CGTC Student ID Number: ______________________ Anticipated High School Graduation Date (MM/YY): ________________
Georgia Testing Identication Number - GTID (not required): _______________________________________________
Amount Due: $_______________ Semester/Year: ______________/________________
Revised 09/16/2020
As the parent/guardian of the student above, I understand the following (please initial each item):
______ My student is registering for college credit hours which may not be eligible for Dual Enrollment funding available
under the Dual Enrollment Funding Program.
______ I am responsible for keeping track of the number of all credit hours attempted and/or earned by my student in the
Dual Enrollment program at any/all colleges and/or universities.
______ If my Student is not eligible for Dual Enrollment funding for a reason listed below, I agree to pay all tuition and
course related fees that are not covered by the Dual Enrollment funding program. (Check all that apply.)
⃣ Enrolled in a course not listed on the GaFutures.org directory. Course Name: ___________________________
⃣ Exhausted the 30 credit hour funding cap
⃣ Enrolled in a General Education (core) course as a 9th or 10th grader
⃣ Failed to maintain Satisfactory Academic Progress (SAP). (67% pass rate AND 2.0 college GPA.)
⃣ Withdrew from two or more courses - no longer eligible for dual enrollment funding
⃣ Retaking a course for which Dual Enrollment funding has already been applied
⃣ Attending a high school that does not participate in the Dual Enrollment funding program
⃣ Enrolled in a course that your high school counselor will not authorize Dual Enrollment funding to cover
______ If my student is eligible for HOPE Grant or HOPE Career Grant funding, I agree and authorize Central Georgia
Technical College to apply the HOPE Grant and/or HOPE Career Grant towards tuition. Central Georgia Technical
College will waive mandatory fees and book costs for all high school students, but course related fees may still
apply.
______ As the parent/guardian of the above named student, my signature on this waiver certies that I have read, understood,
and accepted the above information and the content regarding Dual Enrollment policies found at
www.centralgatech.edu/highschool and www.GaFutures.org.
______ I agree to hold harmless and expressly waive any legal claims that could otherwise be made against Central Georgia
Technical College or the Technical College System of Georgia with regard to any authorized actions taken by the
technical college, or any out-of-pocket payments made by me to enroll my student in Dual Enrollment courses.
______ By providing my GTID number, I consent to allow Central Georgia Technical College to access my student’s Georgia
Department of Education academic record as part of the residency verication process or for other college related
records.
Parent/Guardian Full Name (PRINTED): ______________________________________________________________________________
Parent/Guardian Signature: ____________________________________________________ Date: ________________________
Student Signature: _____________________________________________________________________ Date: ________________________
As set forth in its student catalog, Central Georgia Technical College (CGTC) does not discriminate on the basis of race, color, creed, naonal or ethnic origin, sex, religion,
disability, age, polical aliaon or belief, genec informaon, veteran status, or cizenship status (except in those special circumstances permied or mandated by law). The
following person has been designated to handle inquiries regarding the non-discriminaon policies: The Title VI/Title IX/Secon 504/ADA Coordinator for CGTC nondiscrimina-
on policies is Cathy Johnson, Execuve Director of Conduct, Appeals & Compliance; Room A-136, 80 Cohen Walker Drive, Warner Robins, GA 31088; Phone: (478) 218-3309;
Fax: (478) 471-5197; Email: cajohnson@centralgatech.edu.
A Unit of the Technical College System of Georgia
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