HIGH SCHOOL STUDENT COLLEGE ENROLLMENT FORM
IF COMPLETING NON-ELECTRONIC VERSION, COMPLETE IN BLACK INK AND BLOCK PRINT ONLY
SECTION 1: STUDENT AND PARENT/GUARDIAN
1A. STUDENT INFORMATION
LAST NAME: _________________________________________
FIRST NAME: __________________________________________
ADDRESS: ____________________________________________
CITY, STATE, ZIP: _______________________________________
BIRTHDATE (MM/DD/YYYY): ____________
EMAIL: ______________________________________________
- _) _PHONE: (_______ ______ __________
TCC STUDENT ID#: T___________________
HIGH SCHOOL NAME: ___________________________________
EXPECTED HIGH SCHOOL GRADUATION DATE (MM/YYYY):
Bursar balance owed from prior semester? (Zero balance
required for enrollment): Yes No
Are you enrolling in an Early College High School cohort
program?: Yes No
If so, on what TCC campus is your ECHS
located?: ____________________________
Have you enrolled in any other college or university?
: Yes No
If yes, have you sent the transcript to TCC?
Yes No
1B. COLLEGE COURSE ENROLLMENT: PRINT ONE COURSE PER LINE FOR THE SEMESTER MARKED ABOVE
CRN
(5-digit enrollment code)
DISCIPLINE
(ex. Math)
COURSE #
(ex. 1513)
SECTION #
(3-digit code)
COURSE TITLE:
(ex. Precalculus I)
COURSE SITE:
(ex. West)
CREDIT HOURS:
(ex. 3)
Total college credit hours for calculation
of maximum load
1C. REQUIRED SIGNATURES SECTION: STUDENT AND PARENT/GUARDIAN RESPONSIBILITIES
I understand and consent to the TCC policy guidelines for concurrent enrollment and the TCC student handbook guidelines (see reverse). Enrollment changes must be
completed on the TCC schedule adjustment form. Failure to withdraw by posted deadlines may result in an F grade that cannot be removed and may result in future financial aid
consequences. This enrollment form is only effective for the semester indicated above, and enrollment forms must be submitted each semester. I assume financial responsibility
for any costs associated with this enrollment, and my balance must be paid in full before enrolling in subsequent semesters (see reverse). I give my permission for Tulsa
Community College to share information with my high school designee regarding attendance, grades, academic performance, disciplinary actions, and my student record.
PARENT/GUARDIAN SIGNATURE
SECTION 2: HIGH SCHOOL COUNSELOR
2A. HIGH SCHOOL COUNSELOR INFORMATION
HIGH SCHOOL: _______________________________________
COUNSELOR LAST NAME: ___________________________
FIRST NAME: ______________________________
SEMESTER (CHECK ONLY ONE): FALL SPRING
- ___ SUMMER PHONE: (______) _______ ________
EMAIL: ___________________________________
2B. HIGH SCHOOL SEMESTER INFORMATION
HIGH SCHOOL SEMESTER COURSE SCHEDULE
List one class per line for the semester marked above. List all classes on the high school schedule including technology centers. Schedule not applicable for summer enrollment.
max load count
1 3
2 3
3 3
4 3
5 3
Total high school credit hours for calculation of maximum load
TOTAL college and high school load not to exceed 19 credit hours of academic coursework. (see load policy)
2C. REQUIRED SIGNATURE
I have examined the academic records and certify that the above student is eligible to satisfy high school curricular and graduation requirements no later than the spring
semester of the senior year. I recommend the student be permitted to enroll for the semester indicated above, subject to the guidelines established by the OSRHE and TCC.
(Admission and enrollment proficiency requirements on separate sheet)
PRINCIPAL or COUNSELOR SIGNATURE
SECTION 3: TO BE COMPLETED BY TCC STAFF
TCC SEMESTER GRAD. YR
GPA
ACT/P-ACT:
READ SCI
SAT/PSAT:
COMP RD/WR MATH
ACCUPLACER:
AAF/ACCF: QAS/ACCA: SGASTDN:
TCC STAFF: DATE RECEIVED: COMMENTS:
