D
D
D
D
To be completed by Principal or Designee:
I
certify that for summer session only no more than 5% of our students in any one grade level will be recommended for concurrent enrollment at Citrus
College.
Courses
to be taken should be decided in concert with the school counselor. Students are able to enroll in any degree appropriate courses if the course
prerequisite
is met. The student shall receive college credit for community college courses that have been successfully completed.
Indicate student grade level: 11
th
12
th
Other:
Expected Date of HS Graduation: 20
Principal/Designee Name ( Please Print): Designee Title:
Principal/Designee
Signature: Date:
Please note: The school principal or designee must sign this form. Incomplete forms will not be accepted.
Admissions and Records Office1000 W. Foothill Blvd., Glendora, CA 91741-1899(626) 914-8511 www.citruscollege.edu
**Unless you are a CONTINUING Citrus student, you must also submit an Application for Admission.**
Please use black or blue ink to complete. All areas must be completed; INCOMPLETE FORMS WILL NOT BE ACCEPTED. High School students may
request to concurrently enroll in college courses with the recommendation of their High School Principal and the approval of Citrus College.
Student must complete this:
Student ID Number
Registration Authorization Request for:
Fall Winter
Spring
Summer
Year 20
Student’s Name:
(
)
Last First Middle
Telephone
Student’s Address:
High School: Birth Date:
(Do not abbreviate)
Zip
Mo Day
Year
Course
R
eference
Number
Course
Number
Course Title Units Instructor
09-08
FOR OFFICE USE ONLY:
Form accepted by: Date:
Entered in SAAADMS by: Date:
in
SFASRPO by: Date: in SFAREGS by: Date:
STUDENT Acknowledgement:
I understand that participating in this special enrollment program provides me with an opportunity to enroll in a college course and to access programs and
services available to all Citrus College students. I further understand that I am responsible for knowing and following all college policies and procedures
related to academic performance and student behavior as delineated in the Schedule of Classes and the Citrus College Catalog.
Student Signature: Date:
Approval of Parent or Legal Guardian
I
understand that according to state (ED49061) and federal (FERPA) regulations, parents of a community college student do not have a right to access
their
child’s
student records, regardless of whether the student is under the age of 18. In accordance with this regulation, the student's college records will
be
released to parents only with the written consent of the student.
Parent Signature (required):
Date:
High School Student Registration Authorization
click to sign
signature
click to edit
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