2400 West Bradley Avenue,
Champaign, IL 61821
217/351-2218
www.parkland.edu
Parkland College
Authorization to Enroll at an Illinois Community College
as part of the Career Agreement
The Career Agreement only applies to students seeking enrollment at other Illinois
community colleges for career programs not offered by Parkland College. To apply, this form
must be completed and submitted to the appropriate Division Dean office.
III.
Division Dean Review
II. Student Petition
Division :___________________________________________________
Name: ____________________________________
Address: _________________________________________
City: ___________________________________ State: ______________ Zip Code: _______________________
Cell Phone: ______________________________ Email: ____________________________________________
Community College/District Number you wish to attend: ____________________________________________
Career Program of Study: _____________________________________________________________________
Associate in Applied Science
Certificate
Notification: You will be notified by email of the status of your application request. If approved, this form will be attached to
the email and a copy will be sent to the Illinois community college you will be attending. If denied, the email will include an
explanation of the denial.
General education requirements: You are encouraged to complete the general education requirements for your program at
Parkland College prior to transferring for your desired career program.
_____________________________________________________________________________________________________________________________
Parkland College does not offer the above career program.
________________________________College offers the above career program.
APPROVED: Student is authorized to enroll at ___________________________________________College
under the Career Agreement only for the ___________________________________________career program.
DENIED: Student is not authorized to enroll at _______________________________________________
College under the Career Agreement.
Rationale:
Beginning Term (Semester/Year): ____________________________________________
I. Student Information
_____________________________________________________________________________________________
Dean: Name Signature Date
