Evergreen Valley College
Admissions & Records
3095 Yerba Buena Road
San Jose, CA 95135
P (408) 270-6441 F (408)223-9351
Attendance Approval for Special Part-time High School Students
The student below has been granted approval to attend Evergreen Valley College for the term as a Special Part-time Student.
This permission is for the term indicated ONLY and must be renewed, along with a new application for admission, each
desired term of enrollment.
Please Complete All Fields
Student ID or Last 4 SSN _______________________ Telephone____________________ Email________________________
Name Date of Birth
Last First Middle Initial
Number & Street City Zip Code
High School Now Attending Current Grade Level
Only classes authorized on this form by the High School Counselor/Principal will be valid for credit upon completion. Any and all
other classes registered without authorization from the High School Counselor/Principal will be dropped.
Registration ID #
Course Name
Course Section #
EVC Counselor Initial
(prerequisite verified)
HS Principal/Counselor Initial
In approving this student for enrollment in the class(es) listed on this R-40, the principal confirms that the total number of
his/her high school students recommended to attend EVC courses, adheres to the regulations, and does not exceed the
five percent limit outlined in CA Educational Code 76000/76001. Principal's initials here
**Mandatory Requirements
STUDENT must complete a new application for admissions and submit a current ATTENDANCE APPROVAL form each semester of
STUDENT must meet with the high school counselor to determine which subject areas would be most beneficial.
STUDENT must see that the high school principal signs this ATTENDANCE APPROVAL form.
STUDENT must obtain the signature of his/her parent or guardian on this ATTENDANCE APPROVAL form.
STUDENT must deliver the completed application for admissions and the signed ATTENDANCE APPROVAL form to the Office of
Admissions & Records
STUDENT must meet prerequisite and basic skill requirements for any class in which they intend to enroll.
STUDENT must submit a copy of their high school transcript as part of the multiple measures prerequisite verification process.
STUDENT may opt to take the assessment exam as an alternative to multiple measures for proper course placement.
STUDENT requesting high school credit must consult their high school registrar before enrollment. We grant college credit only.
Most fees are waived for high school students; however, STUDENT should be prepared to pay for any material or transportation fees.
*District policy requires that High School students must attend at least a minimum day at their high school and be in the 9th, 10th, 11th, or
12th grade (exception: Summer Session) to be eligible for admission to San Jose City College/Evergreen Valley College under this program.
Student may enroll in approved courses only, and no more than 11 units for Spring & Fall terms, and no more than 7 units in Summer.
Enrollment fees are waived for High School students. However, High School students must pay any material fees associated with the
courses in which the student has enrolled. Beginning summer 2000, courses taken at San Jose City College or Evergreen Valley College
are offered for college credit only. Upon completion of the term, the student must request a transcript to be sent to the high school of
attendance. The High School will determine if the course may be used for High School Credit.
Signature of Student Signature of Parent or Guardian Signature of HS Principal Date
rev. 3-13-19
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