Fillable Non Public Dual Enrollment Billing Authorization (Lansing Community College)

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Non Public Dual Enrollment Billing Authorization (Lansing Community College)

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File type: PDF

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Non Public Dual Enrollment Billing Authorization Made Accessible via NVDA
N:\FS-Division\SF\1-Adm\Accessibility Forms Updated As of July 25, 2019
Student Finance 309 N. Washington Sq. Suite 200
Lansing, MI 48933
Phone: 517-483-1200; Email: LCC-HSDualEnrollment@lcc.edu
Summer Semester is NOT covered by the Michigan Department of Education.
NON-PUBLIC DUAL ENROLLMENT BILLING AUTHORIZATION FORM
Student Information
The Michigan State Legislature passed Public Act 160 of 1996, the Postsecondary Enrollment
Options Act and Public Act 258 of 2000, the Career and Technical Preparation Act also known as
the "Dual Enrollment" bills. These bills modify and expand on provisions of the State School Aid Act
providing for students to earn college credit while in high school. The bills also require that the
board of a school district or public school academy ensure that each student in eighth grade or
higher be given information about college course taking opportunities. The classes that students
are eligible must not be offered by the high school or academy and must lead towards
postsecondary credit, accreditation, certification and/or licensing.
Non-Public School Information
Name of State-Approved Non-Public School
Number of Classes Considered Full-time at High School
Lansing Community College will transmit a bill to the Michigan Department of Education, detailing
the tuition and fees of the dual enrolled pupil for all eligible courses enrolled. The parent or legal
guardian is responsible for any unpaid tuition and fees on the student account.
Parent/Guardian Information
Last Name
First Name
Banner ID or Username
Date of Birth
Street Address
City, State, Zip
Phone Number
Semester of
Enrollment
(Separate Form
Required for Each
Semester)
Check
Only
One
Year
Fall (begins
August)
Spring (begins
January)
Summer (begins
May)
Non Public Dual Enrollment Billing Authorization Made Accessible via NVDA
N:\FS-Division\SF\1-Adm\Accessibility Forms Updated As of July 25, 2019
Last Name
First Name
Street Address
City, State, Zip
Phone Number
I, understand that as the parent/guardian, am responsible for payment of tuition and fees
even if the student drops classes during LCC’s 50% refund period or LCC’s 0% refund
period. I will assume financial responsibility for costs associated with my child’s
attendance at Lansing Community College, if not covered by any other means. I understand
a FERPA release must be on file to review any of my student’s financial records.
Parent/Legal Guardian’s Signature Date
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Non Public Dual Enrollment Billing Authorization (Lansing Community College)

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Completed 20 July 2020

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