Office of Student Accounts
Dual Enrollment Authorization
Meet with your high school counselor to develop an educational plan for your college dual
enrollment. Have your counselor determine your eligibility under the public Postsecondary
Enrollment Act. Other factors to be decided with your high school counselor are your
enrollment eligibility, course selections and funding for tuition, fees and books.
Students not eligible for funding under the Postsecondary Enrollment Act may choose to dual
enroll through Advancement Plus. Advancement Plus requires that parents of minor children
are responsible for payments of tuition, fees and books.
Bring or send your completed authorization to:
Office of Student Accounts
Welcome Center
5101 Evergreen Road
Dearborn, MI 48128
Fax: 313-845-9826
Anticipated Enrollment Year:
Anticipated Enrollment Term: Fall Winter
Office of Student Accounts
Dual Enrollment Authorization
Student Information
Last Name:
Middle Name:
Date of Birth:
Apt Number:
High School Name:
Home Phone:
State: Zip:
High School City:
Cell Phone:
Work Phone:
Email Address:
First Name:
HANK ID Number:
Office of Student Accounts
Dual Enrollment Authorization
It is understood that Henry Ford College will transmit a bill to the student’s school district
detailing the tuition and fees of the above named student. If the student is enrolled in a
nonpublic high school, the bill will be sent to the State of Michigan.
I acknowledge that this school district is responsible for the lesser amount of: 1) The actual
charge of tuition and fees or 2) the students foundation allowance, adjusted for the proportion
of the school year the student attends our school district. The student is responsible for the
remainder of the tuition and fees, if any. The student is eligible to enroll in the following
course(s) at Henry Ford College as a dually enrolled student.
I certify that the above named student meets all the conditions outlined in the Postsecondary
Enrollment Options Act 160 of 1996, and is currently eligible for dual enrollment at Henry Ford
It is understood that forms must be submitted to Henry Ford College prior to posted
Payment Due Dates to insure classes are not de-registered.
Course Section
Credit Hours
Authorized Signature
High School Counselor Authorization
The student has received the counseling suggested by the Public Acts 160 and the necessary
information about the postsecondary options.
High School Counselor Print and Sign Date
Office of Student Accounts
Dual Enrollment Authorization
Payment Authorization
Tuition Payment (Select One)
School district agrees to pay all tuition and fees
School district authorizes the following amount (exact amount required) $
Non-Public School Michigan Department of Education billed directly
Not eligible for funding under the Postsecondary Enrollment Act. Student/parent
responsible for payment.
District Name/Non-Public School Name
District Mailing Address/Non-Public School Address
High School Principal Print and Sign Date
Parent Signature Date