Name of Student
Soc. Sec. No.
The Student attends
Consent is given for
Richland Community College and enroll in the following courses:
RCC ID#
Su 20
Parent/Guardian Approval Form
Richland Community College | One College Park | Decatur, Illinois 62521
PLEASE PRINT
The above course(s) are to be taken for (check one):
High school credit College credit Dual credit For the term(s) of: Fall 20
Spring 20
I understand that
1) If my son/daughter plans to attend another college or university after high school graduation, I should chek with that
school to be sure the credits he/she will be earning in this program will transfer appropriately.
2) Students participationg in Richland courses will be evaluated as college students and are expected to follow the rules
regulations of Richland Community College. All students will abide by Richland’s Student Rights and Responsibilities
as found in the Student Handbook.
3) Richland Community College students are covered under the “family Educational Rights and Privacy Act” (FERPA),
which prohibits Richland Community College from disclosing information to anyone, including parents, without the
student’s written consent. (Studen may sign below to give consent.*)
4) Course grades and attendance records will be released to the high school for purposes of awarding high school credit.
5) If a student does not complete required coursework, an “Incomplete” may be assigned by the instructor. A student
has 60 days from the end of class to resolve the incomplete grade. It is the studen’s responsibility to remove the “I” so
it can be replaced with the appropriate letter grade. When the “I” grade is replaced with the student’s letter grade,
another grade report will be sent to the high school (dual credit only).
6) Some material presented is for mature audiences.
Signature of Parent or Guardian Date
Signature of Student Date
*My signature below indicates that I give my consent and authorize Richland Community College to release my education
records to:
Name of Parent or Guardian Date
Signature of Student Date
I give High School permission to release my son/daughter’s IEP or information
about accommodations through 504 to the Learning Accommodation Services staff at Richland Community College in
order to arrange for appropriate accommodations.
Signature of Parent or Guardian Date
Signature of Student Date
Name of High School
Name of Student
White - RCC
Yellow - High School
Pink - Parent/Student
R.04.10
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