Fill - Free fillable K-12 Special Admission Process (Palomar College) PDF form

Palomar College | Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 ext 2164

Students may enroll at Palomar College while concurrently enrolled at another school at the K-12 grade level. K-12 Special Admission

students require permission of their high school district and a parent.

K-12 Special Admission students are limited to 7 units in Fall or Spring terms and 5 units in the Summer session.

Please see the following page for further informaon:

hps://www.palomar.edu/pages/enrollmentservices/enrollment-main/steps-enrollment-k12-special-admission/

Follow the steps below to be admied as a K-12 Special Admission student:

STEP 1: Complete the Palomar College Admissions Applicaon. Apply here!

STEP 2: Complete the documentaon listed below for each semester that you are under the age of 18 years or a non-high school

graduate at the beginning of the term or summer session.

 K-12 Special Admission Approval Form*

 Private School/Homeschool: Copy of Adavit with the Superintendent of Public Instrucon required.

 Consent to Treatment of Minor Form*

 Add/Drop Form (Required for minors under the age of 16)

 Unit Peon Form AND Unocial transcripts from all schools ONLY To be submied if student would like to exceed the

allowable unit load for the term or session (unit limits stated above)

*Please note: If the minor student has graduated high school or has received a California High School Prociency Exam Cercate,

then only the student, parent or guardian signature is required on page 1, the K-12 Special Admission Approval form and the

Consent to Treatment of Minor form.

STEP 3: Submit the documentaon: (select preferred method below)

• Via email send ALL documentaon in ONE email to: admissions@palomar.edu

• Via mail to: 1140 W. Mission Rd. San Marcos, CA 92069 An: Admissions

STEP 4: Enroll

• Registraon online is restricted unl the online applicaon and all applicable forms listed in Step 2 have been submied

and processed.

• Students 16 and older: will be able to register for course(s) online via MyPalomar.

• Students under the age of 16: will be manually added to the requested course(s) as long as all required documentaon has

been submied. Students under the age of 16 cannot be added to a waitlist.

STEP 5: Pay Fees

• Enrollment Fees are waived for K-12 Special Admission students who aend Palomar on a part-me basis (<12 units in a term)

• If a K-12 Special Admission student enrolls in 12 or more units, then the student will be considered a full-me student and

will be charged the enrollment fee for all units taken.

• Both part-me and full-me Special Admission students are charged a mandatory Health Fee, Student Center Fee and

Student Representaon Fee in addion to any materials and book fees required of the course.

• Pay required fees online through MyPalomar

Non-residents of California:

• In-state enrollment fees will be waived only, unless the student opts to take the college class for high school credit only. In

that case, the student will be required to submit a Transcript Request Form to have the grade transferred back to the high

school and the non-resident tuion will be waived. If the non-resident student opts to take the class for college credit, then

the student will be required to pay the non-resident tuion.

• SB 150: Special Admission students meeng certain requirements may be exempt from non-resident tuion. Visit our

Residency page for more informaon: hps://www2.palomar.edu/pages/enrollmentservices/residency/steps-to-update-residency/

K-12 Special Admission Process

Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 Ext 2164

Version 05/2021

Palomar College | Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 ext 2164

K-12 Special Admission Approval Form

Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 Ext 2164

Semester/Year:  Summer _______  Fall _______  Spring _______

Palomar Student ID Number

(K-12 Students will be limited to 7 units in Spring/Fall - 5 units in Summer)

Part 1: Student Informaon

I have read the Noce to Minor Students/Parents/Guardians

A. Student's Name - Last, First, MI B. Date of Birth

C. E-Mail D. Expected High School Graduaon Date

Student Signature :

Date :

Part 2: Parent/Guardian Informaon

I hereby peon Palomar College to allow my minor child to enroll in Palomar College while concurrently enrolled in high school and/or while

parcipang in the Dual Enrollment Program or because my student will be under 18 prior to or at the start of the semester. I cerfy that I am the

parent/guardian of the above named student and that I give my consent for their aendance at Palomar College. I have read the aached Noce to

Minor Students/Parents/Guardians. I understand the condions under which my minor child is being admied, including but not limited to fees and

privacy of student records. I am aware that my minor child will be establishing a permanent college record.

Parent/Guardian Signature :

Date :

Part 3: Palomar Instructor Authorizaon (must be completed for students under the age of 16 ONLY)

The instructor signature below does not authorize admiance into a closed class. If the class is closed, please obtain the instructor signature on an

Add/Drop form in addion to the signature below:

Students under the age of 16 must also submit an Add/Drop Form to the Admissions Oce: Add/Drop Form

CLASS NUMBER

(Example: 71303)

COURSE TITLE

(Example: ENG 100)

FACULTY SIGNATURE

Part 4: School Assessment (students who have NOT graduated from high school ONLY)

The above named student meets all the following criteria as dened by Educaon Code 48800-48802 and 76000-76002:

• Is able to benet from the advanced course work

For Summer Session Students ONLY:

• Demonstrates adequate preparaon in the discipline to be studied.

• Has exhausted all opportunies to enroll in an equivalent course, if any, at his or her school of aendance.

• This recommendaon does not exceed 5% of the students at the same grade level. I may exceed the 5% rule if the student is taking classes in

one of the following areas: courses that apply toward the IGETC or CSU GE breadth requirements or are part of a career- technical occupaonal

sequence.

Recommended Course(s):

Counselor/Principal Printed Name :

Counselor/Principal Signature : Date :

******************FOR OFFICE USE ONLY******************

Processed By: __________________

Date: _________________________

Name of School:

 Public  Private

Address (Number and Street) City State Zip Code

School E-mail Address Phone Number

(Year) (Year) (Year)

Residency Code: __________ Student Group: __________

Equaon Variables: __________ Term Acvate: _________ Remove HSGR Hold __________

Version 05/2021

Select only ONE semester

Palomar College | Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 ext 2164

Consent to Treatment of Minor

Semester/Year:  Summer _______  Fall _______  Spring _______

(I) (We), the undersigned parent (s) or guardian of

a minor, do hereby authorize Palomar College Health Services or aending medical personnel as agent (s) for the

undersigned to consent to any X-ray examinaons, anesthec, medical or surgical diagnosis or treatment, or hospi-

tal care which is deemed advisable by, and is to be rendered under the general or special supervision of, any physi-

cian and/or surgeon licensed under the provisions of the Medical Pracces Act, California Business and Professions

Code 112000 et. seq.; or any X-ray examinaon, anesthec, dental or surgical diagnosis or treatment, or hospital

care which is deemed advisable by, and is to be rendered under the general or special supervision of, any denst

licensed under the provisions of the Dental Pracces Act, California Business and Professions Code § 1600 et. seq.

This authorizaon also includes treatment for minors, ages 12-17, provided by licensed Behavioral Health clinicians

within the Behavioral Health Counseling Services Center.

It is understood that this authorizaon is given in advance of any specic diagnosis, treatment or hospital care to

provide authority and power on the part of our aforesaid agent(s) to give specic consent to any and all such diag-

nosis, treatment or hospital care which aforemenoned physician or denst, in the exercise of his/her best judg-

ment, may deem advisable. This authorizaon is given pursuant to the provisions of California Family Code § 6910.

(I) (We) hereby authorize any hospital, which has provided treatment to the above-named minor pursuant to the

provisions of California Family Code § 6910, to surrender physical custody of such minor to (my) (our) above-

named agent(s) upon the compleon of treatment. This authorizaon is given pursuant to California Health and

Safety Code § 1283.

These authorizaons shall remain eecve unl the last day of aendance of the given semester.

Palomar Student ID Number

A. Student's Name (CURRENTLY ON FILE)- Last, First, MI B. Date of Birth

(Student’s Full Name)

Parent/Guardian Signature :

Date :

Name of Parent (Printed) :

Address (Number and Street) City State Zip Code

Home Phone Work Phone

Version 05/2021

Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 Ext 2164

Select only ONE semester

Palomar College | Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 ext 2164

General Informaon for the K-12 Special Admission Approval Form

Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 Ext 2164

Please read the instrucons & general informaon page, as well as the Noce to Minor Students/Parents/Guardians, in their enrety,

prior to subming the completed forms to the Admissions Oce.

Student Informaon

• All secons of this form must be completed for each semester of aendance unl high school graduaon.

• Student must be enrolled in high school and is limited to 7.0 units (5.0 units for summer session) at Palomar College. Students

wishing to enroll in addional units must submit a K-12 Unit Peon along with high school transcripts to the Admissions Oce.

• Student must obtain signatures of both a parent and the high school counselor or principal.

• Student must complete an online Applicaon for Admission (applicaon not required if student is connuing from previous

semester).

• Acceptance of the Applicaon for Admission and this form do not guarantee enrollment into a class. Students must go through the

enrollment process and are subject to all requirements including but not limited to prerequisites, co- requisites, audion and

other enrollment restricons.

• Concurrent Enrollment Only (non-CCAP) - High school students concurrently enrolled part-me in college credit classes are

exempt from the enrollment fee (up to 11.9 units) but subject to all other fees, health fee, student center fee, student

representaon fee and when applicable, the non-resident tuion and capital outlay fees. Fees are due at the me of enrollment.

Failure to pay may result in being dropped from the class.

• Dual Enrollment Only (CCAP) - The intent of the PCCD Dual Enrollment Program is to provide educaonal enrichment for eligible

high school students and to help ensure a smoother transion from high school to college for students by providing them with

greater exposure to the collegiate atmosphere (California Ed Code 48800). Students parcipang in the Dual Enrollment Program

are exempt from payment of enrollment fees (for up to 15 units or 4 classes), mandatory fees (health & accident, student

representaon, student center, and instruconal materials), as well as nonresident tuion and capital outlay fees.

Parent/Guardian Informaon

• Once a student has applied to an instuon of post-secondary educaon, wrien permission or consent of the student is required

to release any informaon pertaining to the student (in accordance with 20 U.S.C. § 1232g; 34 CFR Part 99).

• Palomar College is NOT responsible for providing transportaon, or instruconal materials, including but not limited to textbooks

for students enrolled in the K-12/Concurrent enrollment program.

• Palomar College is NOT responsible for providing transportaon for students enrolled in a Dual Enrollment Program. However, all

instruconal materials are provided for students enrolled in an approved Dual Enrollment Program.

• Review and discuss the Noce to Minor Students/Parents/Guardians with your son or daughter.

• If your son or daughter is under the age of 18, please sign the Consent for Treatment of Minor.

Public and Private School Informaon

• High school counselors or principals may recommend college enrollment for students who have demonstrated adequate

preparaon in the discipline to be studied and can benet from advanced coursework.

• Discuss appropriate course selecon with the student.

Private School Informaon

• Regulaons (48800 and 76001(a)) require that high school students from private high schools may enroll as special part-me

community college students upon peon of the parent.

• Approval for enrollment in college classes will only be accepted from private schools which have led the proper adavit with

the Superintendent of Public Instrucon. A copy of the adavit must be submied along with the Special Admission Approval

Form for students who have not yet graduated from high school.

• Home-schooled students must provide proof of ling as a private school with the Superintendent of Public Instrucon (adavit).

Keep this page for your reference

Version 05/2021

Palomar College | Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 ext 2164

Noce to Minor Students/Parents/Guardians

Oce of Admissions | Admissions@palomar.edu | (760) 744-1150 Ext 2164

Keep this page for your reference

When a minor becomes a student at any college all rights accorded to, and consent required of, parents transfer to the

student (secon 99.5 of the Family Educaonal Rights and Privacy Act). Parents must obtain authorizaon from the

student to inspect the minor student’s records or gain access to informaon related to their aendance at Palomar

College. This authorizaon only grants access to a student's record in- person with photo idencaon, or via USPS. No

personal informaon can be given over the telephone.

Minor students and their parents/guardians must also understand that student is entering a college environment, which

is designed with adults in mind. Thus, the atmosphere of the campus, and of classrooms in parcular, will frequently

reect an adult populaon.

Students/Parents/Guardians should be aware that:

• Courses may have frank discussions about sensive and/or controversial topics that might be considered

oensive to some.

• Audio/visual presentaons may be graphic in their content. Projects and/or assignments may require that

you research sensive and/or controversial topics.

• Students may be exposed to vulgar language outside of the classroom.

• Students may have access to pregnancy and STI/HIV tesng and condoms through the Student Health

Centers.

• Instructors cannot inform anyone, including parents, of last minute class cancellaons or early class

• releases. If classes are released early, instructors are not responsible for underage students while they wait

for pick up.

• Palomar Community College District (PCCD) accepts no responsibility or liability for any extraordinary

supervision of students who are less than 18 years of age and who are not high school graduates.

• Credit earned at PCCD is college credit and will be included on the ocial college transcript. Grades earned

may aect eligibility for future nancial aid, athlec eligibility, academic/progress probaon status, etc.

• Students may have access to computers with open access the Internet. PCCD is not responsible for content

found, read, downloaded, uploaded, transferred or otherwise manipulated on the Internet.

This is not meant to create undue concern – only to serve as a precauon to allow minor students and their parents/

guardians to understand what a college seng is like so that they can have a safe, posive educaonal experience at

Palomar College

If units completed at Palomar College are required for high school graduaon, at the end of the current semester the

student will need to request that an ocial transcript be sent to the high school. Students may view their enrollment

and nal grades through our online registraon system known as eServices.

Rights and Responsibilies of Students

Student rights and responsibilies are outlined in the Palomar College catalog. The catalog is available online through

the college website www.Palomar.edu and includes course informaon and college policies such as grading, course

repeon, enrollment procedures and course transfer. All students are directed to read the secons on Academic

Standards and Policies, Student Support Programs and Services, Student Rights and Responsibilies and Standards of

Conduct.

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