Valley College
S a n B e r n a r d i n o
High School Concurrent Enrollment Petition
r Fall r Spring r Summer 20 ______ High School _____________________
Last Name ________________________________ First ______________________ MI ____________
Address _________________________________________ SBVC ID#___________________________
City _______________________________________ State _______ ZIP ____________ Age _______
Ref# Course Name Section Day(s) Time Units
4356 English 101 06 MWF 10 - 10:50 4
I understand that the courses listed above are for College Credit, and that enrollment at SBVC creates a permanent record that must be reported to
any colleges I apply to in the future. I agree to abide by all rules and regulations set forth in the SBVC Catalog. I also understand that my enrollment at
SBVC will be limited to no more than 11 units per semester, in compliance with Education Code 76001, d.
Signature of Student _____________________________________________ Date __________________ Phone ___________________________
I support this request on the part of my child to attend SBVC. I understand that the courses are for College Credit, and that college courses may contain
content adult content. I understand and agree that my child is subject to the rules and regulations of SBVC as listed in the College Catalog. I also agree
to be responsible for any and all fees incurred by my child in the enrollment process. I am aware that I will not have the right to access my child’s college
records without his/her written consent or a court order.
Signature of Parent/Legal Guardian ___________________________________ Date __________________ Phone _________________________
Pursuant to Education Code 48800, I have reviewed the academic record of this student and certify that s/he demonstrates adequate preparation in
the discipline to be studied and has the ability to benet from college instruction in the courses listed, and if a summer student, s/he has exhausted all
opportunities to enroll in equivalent courses, if any, at his or her school of attendance. For any particular grade level, I certify that I am limiting the number
of recommendations to no more than 5 percent of the total number of pupils who completed that grade immediately prior to the time of recommendation
for this summer session. An ofcial transcript is attached to this petition.
Signature of Principal or Designee __________________________________ Date __________________ Phone ___________________________
r You must take the College Assessment Test - the results will determine
Approved Denied your eligibility for this class.
Comments _________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
President or Designee ___________________________________________ Date ________________
Factors considered in this decision:
r Academic GPA
r Grades in prior classes
r Test Scores
r Recommendations
r Other
COURSES
STUDENT
PARENTPRINCIPALCOLLEGE USE
r Freshman r Sophomore
r Junior r Senior
San Bernardino Valley College
Concurrent Enrollment Information
Student Information
All sections of the form must be completed for each semester of attendance, until high school
graduation.
Students must complete an Application for Admission online each semester.
Acceptance of the Application for Admission and this form do not guarantee admissions to SBVC.
Student must be referred by a local high school, and is limited to ONE course per semester at
SBVC.
Please indicate your high school level at the time you wish to attend SBVC.
Forms and transcripts must be submitted together not separately.
Student is responsible for payment of ALL fees, purchase of textbooks and other required
materials. Fees are due at the time of registration. Failure to pay may result in being dropped
from the class.
Parent Information
Once a student has applied to a post-secondary institution, the Family Educational Rights Act
applies to that student, regardless of age. You will have no access to information about your
student, his/her grades, or performance, without him/her being present.
Student grades are only released by transcript request must be made by the student.
SBVC is NOT responsible for providing transportation or instructional material.
If your son or daughter is under 18, please complete the Confidential Youth Emergency Card.
Home-schooled students must provide proof of filing as a private school with the
Superintendent of Public Instruction OR obtain sign-off form the local public high school the
student would normally be attending. The local high school must be willing to accept home
schooling as valid attendance and determine whether the student has completed coursework
sufficient to prepare him/her to undertake college level coursework.
High School Information
Signatures of high school principals and their designees must be on file with SBVC (contact
Director of Admission for more information).
High school principals may recommend college enrollment for students who have demonstrated
adequate preparation in the discipline to be studied.
Please list specific courses (name and number) which you are recommending for the student.
The student must submit official transcript of all high school work.
The signature of the principle (or designee) on this form indicated that he/she is aware of and is
in compliance with any and all laws and regulations related to this referral, including limiting the
number of recommendations to no more than 5 percent of the total number of pupils who
completed that grade immediately prior to the time of recommendation for a summer session.
05/13
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