NEW COURSE APPLICATION FOR DUAL CREDIT
100 College Drive ● Kankakee, IL 60901-6505 ● 815-802-8816 ● FAX: 815-802-8101
ONE FORM PER COURSE, PLEASE.
This form is to be submitted to KCC for approval no later than April 30 for new Dual Credit course requests
for the following fall or spring semesters. “New” pertains to courses not offered before for dual credit by
the high school. Also submit the Dual Credit Course Application.
Today’s date: _____________________________
High school: _________________________________________________________________
High school instructor: _________________________________________________________
Phone number: ___________________________
Instructor’s high school email: ___________________________________________________
KCC course number and/or name: ________________________________________________
Requesting for school year __________________
Semester(s) to offer dual credit course?
❒ Fall ❒ Spring
How many sections will you offer per semester? (choose one) ❒ 1 ❒ 2 ❒ 3
❒
Attach a copy of the dual credit course syllabus.
❒ If a new instructor, attach a copy of post-secondary transcripts to verify teaching credentials. Transcripts do
not have to be sent if they are on file at KCC.
I agree to abide by the policies and procedures related to teaching courses for KCC articulated in the dual
credit manual, including grading standards and course outcomes. I understand that no compensation will be
provided to me by KCC for any services in the Dual-Credit Program.
Instructor signature: ____________________________________________________________
Date: _______________
_____________________________________
Office use only
____ FASC – incl assoc dean
____ SOFF
____ Notify DC dir & assoc dean
