Divis
ion of School Finance
POSTSECONDARY ENROLLMENT OPTIONS
EARLY/MIDDLE COLLEGE PROGRAM NOTICE
OF STUDENT REGISTRATION
ED-02476-04
NOTE: Complete a separate form for each instructional term, AND for each postsecondary institution attending. Please print and
use black ink. ALL BOXES MUST BE COMPLETED.
School Year: 2019-2020 College Student ID Number:
1. TO BE COMPLETED BY THE STUDENT
Student Name (Last, First, M.I.):
Select Gender:
M F
Date of Birth (MM/DD/YYYY):
Address:
City:
Zip Code:
Student Email:
Postsecondary institution you plan to attend this term:
Parent/Guardian Name:
Minnesota Statutes, section 124D.09, requires that the student and parents/guardian sign a form indicating they have received information about
the program, are aware that counseling services are available and understand the responsibilities regarding enrollment in postsecondary courses.
Signature Student Signature Parent/Guardian (if student is under 18) Date
Please pass this form to the State Approved Alternative Program (SAAP) for completion of section two.
2. TO BE COMPLETED BY THE STATE APPROVED ALTERNATIVE PROGRAM (SAAP)
Name of State Approved Alternative Program (SAAP):
SAAP 3-digit
Number:
13-Digit MARSS Student Number:
Name of Enrolling School District:
During period of attendance at postsecondary institution student’s secondary grade
level will be:
Grade 11 *Public Students Only
Grade 12 *Public Students Only
NOTE: HIGH SCHOOL GRADUATES AND 21 YEAR-OLDS
ARE NOT ELIGIBLE
Student may not enroll in PSEO in addition to a full high school course load.
Does the student have reduced high school instructional time? YES NO
Is the student enrolled full-time in SAAP:
YES NO
Is the student eligible for program application?
(see page 3 for requirements) YES NO
IF NOT ELIGIBLE, RETURN FORM TO STUDENT, DO NOT
CONTINUE PROCESSING.
STATE APPROVED ALTERNATIVE PROGRAM (SAAP) VERIFICATION
I certify that the student identified in section 1 meets the eligibility requirements outlined in Minnesota Statutes, section 124D.09, to apply for
participation in the Postsecondary Enrollment Options (PSEO) program this term, and that the information in section 2 is accurate and applicable
to the student.
Signature - Secondary School Contact Person: Date:
Secondary School Contact's Name (printed):
Title:
Email Address:
Telephone Number:
Please pass this form to the Postsecondary Institution for completion of section three.
POSTSECONDARY ENROLLMENT OPTIONS EARLY/MIDDLE COLLEGE PROGRAM NOTICE OF STUDENT REGISTRATION ED-02476-04 Page 2
Student Name (Last, First, M.I.):
Date of Birth (MM/DD/YYYY):
College Student ID Number:
3. TO BE COMPLETED BY THE POSTSECONDARY INSTITUTION
Name of Postsecondary Institution:
Postsecondary Institution Number:
City of Postsecondary Institution:
Term of Planned Attendance (Select one only): Summer Qtr 1 Qtr 2 Qtr 3 Qtr 4 Sem 1 Sem 2
Postsecondary Institution Contact Person:
Title:
Email Address:
Telephone Number:
COURSES TAKEN FOR DEVELOPMENTAL EDUCATION CREDIT ONLY
COURSE NUMBER
COURSE CREDITS
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
5.
5.
5.
6.
6.
6.
COURSES TAKEN FOR POSTSECONDARY CREDIT ONLY
COURSE NUMBER
COURSE CREDITS
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
5.
5.
5.
6.
6.
6.
POSTSECONDARY REGISTRATION VERIFICATION
I certify that the student identified in section 1 is registered this term for the courses indicated, that all courses indicated are non-sectarian in
content, and that the student has indicated to me that the courses are to be taken for secondary credit.
Signature Title Date
The postsecondary institution must mail a LEGIBLE copy of this form within 10 days to the Minnesota Department of Education at
the following address:
Minnesota Department of Education
Division of School Finance
1500 Highway 36 West
Roseville, MN 55113
Additionally, copies must be returned to the student indicated in section 1 and the State Approved Alternative Program of
attendance indicated in section 2.
POSTSECONDARY ENROLLMENT OPTIONS EARLY/MIDDLE COLLEGE PROGRAM NOTICE OF STUDENT REGISTRATION ED-02476-04 Page 3
POSTSECONDARY ENROLLMENT OPTIONS EARLY MIDDLE COLLEGE PROGRAM
L
egislation passed in 2014 provides the opportunity to leverage Postsecondary Enrollment Options (PSEO) funding for
developmental coursework under specific circumstances. In Subdivision 9 of Minnesota Statutes, section 124D.09 the
following language has been added to an existing clause:
A
n institution must not enroll secondary pupils, for postsecondary enrollment options purposes, in remedial,
developmental, or other courses that are not college level except when a student eligible to participate in the
graduation incentives program under section 124D.68 enrolls full time in a middle or early college program
specifically designed to allow the student to earn dual high school and college credit. In this case, the student shall
receive developmental college credit and not college credit for completing remedial or developmental courses.
S
TUDENT ELIGIBILITY - Refer to Minnesota Statutes, section 124D.68, and section 124D.09
S
tudents are considered eligible if they are enrolled in a core school day state approved alternative program under the
graduation incentives program as defined by the Minnesota Department of Education.
A
. A student must be enrolled in school in the 11
th
or 12
th
grade;
B. A
student who enters the program:
1) A the beginning of the 11
th
grade year may continue in the program for the equivalent of two academic high
s
chool years, except for state approved Learning Year Programs pursuant to Minnesota Statutes, section 124D.128.
2) At the beginning of the 12
th
grade year a student may continue in the program for the equivalent of one academic
high school year.
C. Fo
r purposes of determining PSEO eligibility, the student must have reduced instructional time in the secondary
setting. Students cannot access PSEO on top of a full course load at the state approved alternative program.
D. I
n either case, if the student first enters the program during the academic year, the window of opportunity is reduced
proportionally.
E. I
f a student withdrew from high school for medical or other unavoidable reasons prior to the beginning of the
postsecondary institution’s 2
nd
semester and generated no general education revenue through the remainder of the
school year after withdrawal, the student would be eligible to extend eligibility by one semester.
F. An institution shall not enroll secondary pupils, for postsecondary enrollment options purposes, in sectarian, remedial,
developmental, or other courses that are not college level unless the student is participating full-time in a state
approved alternative program and early/middle college program designed to help the student earn a certificate or
degree.
G
. In 2003, the PSEO law was amended so that the books are now returned to the college not the high school. Minnesota
Statute, section 124D.09, Subdivision 20 (2002), is amended to read: Subdivision 20, TEXTBOOKS; MATERIALS. All
textbooks and equipment provided to a pupil, and paid for under subdivision 13, are the property of the pupil’s
postsecondary institution. Each pupil is required to return all textbooks and equipment to the postsecondary
institution after the course has ended.
For more
detailed information on the program and its requirements, please view the Postsecondary Enrollment Options
Program information (http://education.state.mn.us/MDE/fam/dual/pseo) on the Minnesota Department of Education’s
website.
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