Fillable PERMIT FOR SPECIAL K-12 STUDENTS TO ATTEND MERCED (Merced College)

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PERMIT FOR SPECIAL K-12 STUDENTS TO ATTEND MERCED (Merced College)

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MERCED COMMUNITY COLLEGE DISTRICT
Admissions and Records Los Banos Campus
3600 M Street 22240 Highway 152
Merced, CA 95348-2898 Los Banos, CA 93635
PERMIT FOR SPECIAL K-12 STUDENTS TO ATTEND MERCED COLLEGE CLASSES
Merced Colleges Board Policy 5010 requires written recommendation from the K-12 school principal or the principal’s designee before a K-12 student may be admitted as
a special part-time or as a special full-time student. Merced College also requires permission of parent(s).
NOTE: MC Placement test is required for students enrolling in English, Math, or in 6 or more units: call 384-6000 for details on testing or on admissions/residency.
TO BE COMPLETED BY STUDENT: Term: Fall Spring Summer ___________ (yr.) Date: __________________________
Merced College ID number: __________________ Grade Level (K-12) during term: __________ High school attending: _____________________
PRINT Student Name: _________________________________________________________ Phone Number: (______) _____________________
Student Address: ___________________________________________City:________________________ State: __________ Zip: ________________
Emergency Contact Information:
Name ___________________________________________Relationship________________________ Phone Number: (_____) _________________
TO BE COMPLETED BY APPROVING K-12 PRINCIPAL OR DESIGNEE: (ONE COURSE PER FORM)
SPECIAL PART-TIME student is one enrolled in 1-11 units o
r not subject to enrollment fees. FULL-TIME student is one enrolled in 12 or more units and subject to all fees.
Academic Term Course Name /Section Number Number of Units
*By signing this form,we certify that this student has demonstrated adequate preparation and has availed him/herself of opportunities to enroll
in “equivalent” courses in the district(s) of attendance. We recommend this class, if approved by college officials:
________________________________________________
_ PRINT Name and Title of Approving K-12 Official
_____________________________________________________ *
SIGNATURE of Approving K-12 Official Date
For Summer Session Enrollment: By signing this form the K-12 Official verifies that this approval is within the Title 5 requirement of no more than 5% of the prior term’s respective class
TO BE COMPLETED BY COLLEGE OFFICIAL: (Signature indicates approval for student to attend)
Conditions, if any: ____________________________________________________________________________________________
Any Physical Education Course:
Vice-President of Instruction Approval
Date
MC FORM 1241: REV 04/18
9
th
TO-12
th
grade student:
_______________________________________________________________________________________
College Counselor Approval Date
8th grade student:
or below;
_______________________________________________________________________________________
College Counselor Approval
Date
______________________________________________________________________________________
Area Dean Approval
Date
I have read and understand the guidelines stated on the reverse side of this form: Student Initial ___________ Parent Initial ____________
Parent Signature: I approve my
child to take the class listed below: (required unless proof of emancipation): ___________________________________
I authorize Merced College to share Grade and Attendance information with my designated High School District for any dual/concurrent
enrollment course.
Student Signature ________________________________________ Parent Acknowledgement ____________________________________
K-12 Enrollment at Merced College Parent/Guardian Information
Thank you for your interest in and support of education. Merced College wants each student’s experience to be positive and successful,
and we believe the information below is important for you to know.
Parents or guardians of K-12 students should understand that Merced College classes are not an extension of secondary school classes
and that there will be significant differences in educational experience. The items for your consideration, which are guidelines related to
K-12 students, include:
1.
K-12 students must be present or have given signed written permission to their parent/guardian in order to enroll in
classes.
2.
K-12 students are required to pay for the mandated health fee and for their textbooks or other
required classroom supplies. (If the K-12 student is enrolling for fewer than 12 units, no enrollment
fees will be assessed other than the health fee). The Student rep fee ($2) and the student body
fee ($5) may be waived if the appropriate forms (http://www.mccd.edu/resources/fees/forms.html) are
completed and turned in to the Student Fees Office by the end of the first week of the term you
are enrolling in.K-12 students are3. K-12 students taking 12 units or more will be subject to all per unit fees as well
as the mandated fees associated with enrollment. The Student rep fee ($2) and the student body fee ($5) may be waived
if the appropriate forms (http://www.mccd.edu/resources/fees/forms.html) are completed and turned in to the Student
Fees Office by the end of the first week of the term you are enrolling in.
3.
4. K-12 students will be held to the same grading standards as adult students. Their grades will become a part of a
permanent academic record at Merced College
4.
5. K-12 students taking AB288/CCAP classes acknowledge that grades earned from these classes will be shared with
the students High School district office.
5.
K-12 students may be in an adult instructional environment. The community college is an adult learning environment
and reflects a diverse community of learners. Discussion topics and course materials are generally designed for adult
students and may not be appropriate for younger students. Course content will not be changed to accommodate minors.
6.
K-12 students will not receive special counseling or support from the college’s student services programs beyond
what is provided for older students.
7.
Merced College assumes 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 canceled and/or dismissed early
8.
K-12 student educational records are considered confidential. Parents or guardians are not notified and may not
obtain student academic or financial records without the signed written permission of the student as stated by the Family
Educational Rights and Privacy Act (FERPA). Students MUST be present to sign the authorization to release student
information form in front of an authorized Merced College staff member. Educational Records are defined as those
records that contain information directly related to a student and which are maintained by an educational agency or
institution or by a party acting for the agency or institution.
9.
K-12 student educational records are considered confidential. Parents or guardians are not notified and may not
obtain student academic or financial records without the signed written permission of the student as stated by the Family
Educational Rights and Privacy Act (FERPA). Students MUST be present to sign the authorization to release student
information form in front of an authorized Merced College staff member. Educational Records are defined as those
records that contain information directly related to a student and which are maintained by an educational agency or
institution or by a party acting for the agency or institution.
I
f
you have any questions about the appropriateness of the student’s enrollment at Merced College, you are encouraged to
speak with their school counselor, and/or the college
.
Revised 05/24/20
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PERMIT FOR SPECIAL K-12 STUDENTS TO ATTEND MERCED (Merced College)

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Completed 12 March 2021

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