High School Dual Credit Program
Petition to Enroll in 10 or More Credit Hours
South Dakota Board of Regents
Black Hills State University – Dakota State University – Northern State University
South Dakota School of Mines & Technology – South Dakota State University – University of South Dakota
High school students participating in the Dual Credit program may request to register for up to a maximum of nine (9) credit hours
each term. Students may request a waiver of the nine (9) credit hour limit by completing and submitting the petition below to your
campus’s Dual Credit Contact.
Petition Eligibility Requirements:
☐ 1. Student must meet HSDC Admission Criteria and be admitted to one of the SDBOR University HSDC
programs.
☐ 2. Student must have previously completed one or more SDBOR HSDC courses.
☐ 3. Student must have received a final grade of “B” or higher in all previous SDBOR HSDC courses OR have a 3.0 cumulative GPA
in all SDBOR HSDC coursework.
Legal Name: Social Security Number:_____________________________________
Last – First – Middle XXX-XX-XXXX
Date of Birth: ____________________________________
Date/Month/Year
Use of Social Security Number (SSN) - Privacy Information: We are requesting your SSN for administrative record accuracy and reporting. Disclosure of your SSN is
voluntary and if you decline to provide it to us this action will not affect your admissions eligibility. However, we request this information from you in order to meet our
federal obligation to report student employment, Hope and Lifetime Scholarship tax information, and federal financial aid. The SSN is confidential information under the
Federal Educational Rights to Privacy Act and we will not release it without your consent. Having your SSN on record will enable the University to keep accurate
information and to report it promptly.
Course Information:
SDBOR University admitted to: ☐ BHSU ☐ DSU ☐ NSU ☐ SDSM&T ☐ SDSU ☐ USD
Semester waiver requested: Fall 20___ Spring 20___ Summer 20___
Subject
Course Title Credit Hours
Student Signature: __________________________________________________________ Date: ________________
Parent/Guardian Signature: __________________________________________________ Date: ________________
School Official:
With my signature below, I verify that all student information on this application is complete and accurate to the best of my knowledge.
I
verify that I have read and understand the enrollment requirements for the High School Dual Credit Program, and that the student
meets these requirements. I verify that the student’s high school has signed an MOU with the Dept. of Education.
School Official Signature: ____________________________________________________ Date: ________________
School Official Name: ______________________________________
Phone: ____
______________
Email: ________
______________________
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