Form YS-1 Effective 8/30/2017
LOS ANGELES COMMUNITY COLLEGE DISTRICT
SUPPLEMENTAL APPLICATION FOR ADMISSION OF STUDENTS IN GRADES K-12
ADMISSION: Colleges in the Los Angeles Community College District (“LACCD”) may admit as a special part-time or full-time student anyone who is a student in grades K-12 who has met
the LACCD’s admissions requirements and who, in the opinion of the College President (or designee), may benefit from instruction. (Education Code sections 48800, 48800.5, 76001;
LACCD Board Rules 8100.06, 8100.07, 8100.08; LACCD Administrative Regulation E-87.)
FEES: Enrollment fees are required for special full-time students (i.e., taking more than 11 units), but waived for special part-time students (i.e., taking 11 units or less). (Education Code
section 76300(f), LACCD Board Rule 8100.03.) Special part-time students are exempt from the nonresident tuition fee (Education Code section 76140(a)(4), LACCD Board Rule
8100.03.) The LACCD also charges a health fee (certain categories of students are exempt) and, where applicable, a student representation fee.
Students enrolled in CCAP programs are exempt from enrollment fees and will not be charged for textbooks, equipment, and materials.
CONDITIONS: The student is expected to follow regulations and procedures that apply to all college students. The student shall receive college credit for the community college courses
that the student completes. Arrangements for receiving high school credit for completed course work must be made with the student’s high school. The student may only enroll in those
courses listed on this form. This enrollment approval form must be presented when the student initially files an application for admission to the college, and a separate approval must be
provided for each semester or term in which the student wishes to enroll. The LACCD and its colleges assume no responsibility for the supervision of minor students (i.e., students
under 18 years of age) outside the classroom setting. Parents are responsible for ensuring that their children are appropriately supervised before class begins, after class
finishes, or when a class is cancelled and/or dismissed early.
K-12 STUDENT INFORMATION
Student Name: __________________________________________________________________________ Birth Date: ____/_____/______
Last First MI Mo Day Year
Student Address: ______________________________________________________________________________________________________________
Street City State ZIP
Phone No.: __________________________________ E-mail address: ________________________ Student I.D. No.: ____________________________
Student Grade: ______________________________
FOR STUDENT: I authorize the release of my transcript information to my school upon the school’s written request.
______________________________________________ _____________________________
Signature of Student Date
FOR PARENT/GUARDIAN: I authorize my son/daughter to enroll in a college level course in the LACCD. I understand that my child will not be afforded any
special status or supervision as a result of his/her minor status while enrolled in the Los Angeles Community College District; I also understand that I will not
have access to my child’s student records (including grades and transcripts) without his/her written consent, his/her minor status notwithstanding.
________________________________ ________________________________ _____________ _____________________________
Print Name of Parent/Guardian Signature of Parent/Guardian: Date
COLLEGE ENROLLMENT INFORMATION
(to be completed by the K-12 school official)
Spring Semester
Summer Session
______________________
Term: Fall Semester Winter Intersession
Year: _
College: _________________________________
Enrollment Status:
Part-time (11 units or less)
Full-time (more than 11 units)
1. ________________________________________ 2. ______________________________________ 3. ______________________________________
College Course Subject/Number College Course Subject/Number College Course Subject/Number
4. ________________________________________ 5. ______________________________________ 6. ______________________________________
College Course Subject/Number College Course Subject/Number College Course Subject/Number
I have met and counseled the student and recommend the courses listed above to be taken for credit (for K-8 students, please enclose the student’s transcripts
and letter describing how, in your opinion, the student will be able to profit from instruction at a community college). If this is a summer enrollment, I certify that
there are no equivalent courses available at this school and that the total number of students referred from this school to community colleges does not exceed
5% of this year’s graduating class.
___________________________________ _________________________________________ ____________________________________
Print Name of Official Signature of Official (original required) Date
FOR LAUSD STUDENTS: _____________________________________ ____________________________________________
LAUSD Student I.D. No. School Location Code
COLLEGE APPROVAL
(to be completed by the College’s Chief Instructional Officer (or designee)
Approved to Attend Not Approved to Attend _____________________________________ _____________________________
Signature Date
Reason(s) for Refusal: ____________________________________________________________________________________________________________
TUTOR 001T
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