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Peralta Community College District Admissions and Records (Berkeley City College)

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Peralta Community College District
Admissions and Records
Berkeley City College
College of Alameda
Laney C ollege
Merritt College
ELEMENTARY AND MIDDLE SCHOOL SPECIAL ENROLLMENT
The Elementary and Middle School Special Enrollment provides enrichment opportunities for elementary and middle
school students who can benefit from college level instruction.
The Peralta Community College District (PCCD) may admit a limited number of elementary and middle
school students who have exceptional ability, or who desire specialized or advanced training. Such admission
must be with the recommendation of the principal and approval of the parent or guardian.
Elementary and middle school students enrolling in a college level course must meet assessment
requirements. The student must follow all the regulations and policies of the college, including adhering to
any prerequisite requirements.
Special part-time enrolled elementary/middle school students are exempt from paying the California
Community College enrollment fees and all other fees. Elementary and middle school students may not
enroll in more than 1 class per semester except during the summer term. Elementary and middle school
students who would like to enroll in more than 6 units during the summer term must obtain permission
from the college VP of Student Services or designee prior to enrollment (Elementary/middle school
transcript required).
* Elementary and middle school students admitted to the Peralta Community College District earn actual
college credits which may affect their financial aid eligibility in future semesters.
All college coursework is governed by the Family Rights and Privacy Act which allows release of academic
information, including grades, to the student only- regardless of age. Academic information is not released to
parents or third parties without the consent of the student.
Steps for the Elementary and Middle School Special Enrollment:
1. Go online to http://web.peralta.edu/admissions/high-school-students/elementary-middle-school-students/
to download the admission application for the Peralta Community College District.
2. Complete and take this Elementary and Middle School Special Enrollment form to the school’s Principal to
obtain his/her signature.
3. Submit the completed admissions application and the Elementary and Middle School Special Enrollment
form to the Admissions & Records office.
4. You must fill out a separate form for each semester.
I have read the above and authorize my child’s enrollment in the Elementary and Middle School Special
Enrollment.
Parent or Guardian’s Signature:
Date:
ADMISSIONS AND RECORDS USE ONLY
Processed by:
Date:
TURN OVER
Rev. 04/18/2016 1
Peralta Community College District
Admissions and Records
ELEMENTARY AND MIDDLE SCHOOL SPECIAL ENROLLMENT
Berkeley City College
College of Alameda
Laney C ollege
Merritt College
For the: Summer Fall Spring Year: 20 Grade Level (on the 1
st
day of the college term):
STUDENT INFORMATION
Student’s Name: Student ID:
Last Name First Name M.I. or last 4 digits of SSN
Date of Birth: Email: _
Address:
Street City State Zip Parent or
Guardian’s Name:
Phone: ________________________
Email
: ________________________________
Parent, Student, Principal – please read the following information:
*By entering a college environment, students who are minors will be exposed to a diverse population in educational programs designed for the adult
learner that may involve sensitive topics that might be considered controversial or offensive in the secondary school setting.
*If a class does not meet at its scheduled time (i.e. cancelled class or ends early), the PCCD does not inform parents or guardians nor will staff or the
instructor assume responsibility for students once class is released.
Student’s signature: Date:
Parent or Guardian’s Signature: Date:
AUTHORIZATION FOR THE ABOVE STUDENT TO ENROLL IN SELECTED COURSES IN THE PCCD
School Currently Attending:
School Location:
Street City State Zip
School Principal's Signature and Seal/Stamp: Date:
*Per Education Code Section 48800, for summer sessions, K-12 principals may not recommend more than five percent of the
number of pupils who have completed a particular grade immediately prior to the time of the recommendation.
SCHOOL DISTRICT AUTHORIZATION (for Home Schooled Students only)
**Home School Students must provide clearance from their local school District.
District Official’s Name: Phone:
District Signature: Date:
AUTHORIZED CLASS SCHEDULE
CLASS
CODE
DEPT. &
COURSE #
COURSE TITLE
HOURS
DAYS
ROOM
UNITS
Total # of units:
VP OF   OR DESIGNEE (for
students taking 6 or more units only)
VP of   (or designee) Signature: __________________________________
Rev. 04/18/2016
Date:
2
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Peralta Community College District Admissions and Records (Berkeley City College)

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Completed 25 July 2020

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