To Be Completed By High School Officials (Each Semester)
Student Name: High School:
Expected Graduation Date:
Enrollment Semester: Summer Fall Spring Year
Redlands Course Desired by Student: (please indicate whether it is On Campus or Off Campus (IETV or Online)
Course Title Dept. Course # Section # Credit Hours
Course Title Dept. Course # Section # Credit Hours
Accredited High School:
Home School / Unaccredited High School:
Juniors &
Minimum 19 ACT Composite
3.0 unweighted high school GPA
AND a 19 in the appropriate
subject area.
A student receiving high school level
instruction at home or from an
unaccredited high school must have a
transcript reflecting completion of enough
high school credits to be classified as a
Junior (11 total units) or a Senior (16 total
* Students who meet the ACT Composite scores and/or GPA requirements, but do not meet the individual
subject area ACT scores are eligible to take the Redlands Placement Test to determine eligibility.
I hereby certify that the above named student meets the published admission requirements, is eligible to
satisfy graduation requirements (including curricular requirements for college admission), and that his or
her combined high school and college enrollment does not exceed the equivalent of 19 college semester
hours. As a result, I recommend that he or she be permitted to enroll in the above named course(s) for
the following semester.
Number of high school credit courses
(multiply by three)
Equals total high school workload
(plus) number of college credit hours
Equals total workload hours
High School Counselor Signature
** Total workload hours cannot be greater than 19,
unless you are a student who qualifies for an
extension of credit hours. Please contact a Redlands
Concurrent Advisor to see if you qualify.**
High School Principal or Superintendent Signature
To Be Completed By Student and Parent (Each Semester)
We understand that in order to continue enrollment as a high school concurrent student a
minimum 2.0 college GPA must be maintained.
We understand that any schedule adjustment or withdrawal must be approved by the High
School Counselor. Failure to withdraw may result in an “F” grade that cannot be removed.
We understand that courses taken for dual credit may affect high school graduation eligibility. If
I drop/withdraw from a concurrent course, I must notify my High School Counselor immediately.
Tuition Cost:
Concurrent tuition is waived up to 18 credit hours starting the summer semester before senior year.
-Junior: Concurrent tuition is waived up to nine credit hours.
All concurrent students are responsible for the cost of textbooks and any fees associated with their
classes (lab fees for science classes, etc.).
I have read and understand the provisions set forth by my high school and Redlands Community College
for my concurrent enrollment. I give permission for Redlands to release my test scores, grades,
attendance information, and Redlands transcripts to my high school and parent/legal guardian for the
duration of my concurrent enrollment.
Signature of Student Print Name of Student Date
I have read and understand the provisions set forth by the high school and Redlands Community College
for my son’s or daughter’s concurrent enrollment. I agree to the terms of payment as indicated in the
Redlands Community College Course Catalog.
Signature of Parent/Legal Guardian Print Name of Parent/Legal Guardian Date
Financial Responsibility
Last First MI
Social Security Number _______________________________ Date of Birth _________________
Required Required
Billing Address_________________________________________________________________________
Street, Route or Box Number City/State/Zip
Phone Number __________________________________ Email ________________________________
Required Optional
*By signing this form, you agree to the terms and condition outlined in Redlands Community College Academic
Catalog about tuition/fee payment. If the responsible party signing the agreement is under the age of 18, he/she
agrees that services receiving at Redlands Community College is considered necessity, and agrees to be
contractually obligated pursuant to the “doctrine of necessaries.”
Signature Print Name Date
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