Fillable Postsecondary Enrollment Options Notice of Student Registration Form (North Hennepin Community College)

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Postsecondary Enrollment Options Notice of Student Registration Form (North Hennepin Community College)

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Postsecondary Enrollment Options
Notice of Student Registration Form 2022-23
ED-001763-23
Instructions: Complete
a Notice of Student Registration Form (NOSR) for each student's term and postsecondary
institution (PSI). Once Sections 1 and 2 are completed, work with both your high school
and postsecondary institution
to ensure your Section 3 courses fulfill an unmet academic graduation requirement.
Eligibility: Courses in Section 3 may only be those that fulfill a student's unmet academic graduation requirements as
courses for postsecondary credit
only are ineligible. This form is submitted by the postsecondary institution to
Minnesota Department of Education (MDE).
1. Student and Parent/Guardian Complete and Sign This Section
Male
Female
Unreported
Student Name (Last, First, M.I.)
Birthdate (MM/DD/YYYY)
Address
City
ZIP Code
Phone
Postsecondary Institution This Term
Parent/Guardian Name
Address (if different from student)
Public
School Students: Minnesota Statutes 2021, section 124D.09, subdivision 7, to assist the di
strict in planning a pupil
must inform the district by May 30 of each year the pupil’s intent to enroll in postsecondary courses during the following
school year. A pupil is bound by notifying or not notifying the district by May 30. If the
district has not waived the deadline,
I/we may responsible for the postsecondary course
cost.
Date I/we notified the district the intent to enroll in PSEO for either semester, school year 2022-23.
All Students: Minnesota Statutes 2021, section 124D.09,
subdivision 6, Prior to enrolling in a course the pupil
and pupil's
parent/ guardian must sign a form stating they have received PSEO information (including transportation); know counseling
services are available; understa
nd PSEO responsibilities and ar
e aware the student is enrolling
in PSEO
courses.
My signature(s) below indicates I/we are aware that if the course(s) registered for do not fulfill unmet academic
requirements for graduation, I/we may be responsible for the postsecondary course costs.
Student Signature
Parent/Guardian Signature
Date
(if student under 18)
.
2. To be Completed by Secondary/Nonpublic/Home School
Home School
Public Nonpublic
Secondary/Nonpublic/Home School Name
Secondary School Type
(Select one) Public Student SSID* Number
Attending Public School District Name
Attending Public School District Number (xxxx-xx)
Student grade level during the 2022-23 school year. (Select one): Grade 10 Grade 11 Grade 12
Eligibility Note: High school graduates and/or students who have fulfilled all of their academic requirements for
graduation, and 21-year-olds are not eligible. Students must also give up one period in their high school day.
Does this student have at least one free class period during the high school day? Yes No
No
Is the above student eligible for program application? (See Page 3 for requirements) Yes
Public School: The student in Section 1 meets both PSEO student and course eligibility requirements for this term as
outlined on pages 3-4 and the student information in Section 2 is accurate. The public school student notified the
enrolling district of intent to enroll by May 30, 2022, or the school district has waived the deadline requirement.
.
Secondary School Contact Name Contact Signature Email Phone Date
MDE College Student ID Number:
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signature
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signature
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ED-01763-23
Page 2 - PSEO Notice of Student Registration 2022-23
2022-23
Student Name (Last, First, M.I.)
Date of Birth
(MM/DD/YYYY) MDE College Student ID Number
3. To be Completed by the Postsecondary Institution
Name of Postsecondary Institution
PSI Number (xxxx-xx) City of Postsecondary
Term of Attendance (Must Select one)
Semester 1
Semester 2
Qtr 1 Qtr 3
Qtr 2
Postsecondary Institution Contact Name
PSI Contact Email
Telephone
Courses Taken for Secondary and Postsecondary Credit
Course Number
Course Credits
Course #1
Course #2
Course #3
Course #4
Course #5
Course #6
Minnesota Statutes
2
021, sec
tion 124D
.09, subdivi
sio
n 7, requ
ires pu
blic sc
hool stud
ent
s to inf
orm
the distric
t by
May
30 o
f eac
h yea
r o
f th
e pupil
’s intent t
o enro
ll
in postsecondar
y course
s durin
g th
e followin
g scho
ol yea
r t
o assi
st the
district i
n p
lanning. A
p
upil i
s b
ound b
y n
otifying o
r n
ot notifying t
he d
istrict by M
ay 3
0, u
nless t
he p
ublic school
district h
as w
aived t
he d
eadline a
s i
ndicated i
n S
ection 2
o
f t
his f
orm. O
nly p
ublic school s
tudents w
ho h
ave m
et this
requi
rement are eligib
le for PS
EO
fundi
ng.
Minnesota
Statutes 2
021, sec
tion 124D
.09, subdivi
sio
n 5, requ
ires
the institu
tio
n to s
end wri
tten no
tic
e to
the student
and t
he s
tudent’s s
chool o
r d
istrict. T
he n
otice m
ust i
ndicate t
he c
ourse a
nd h
ours o
f e
nrollment o
f t
hat p
upil.
My signature below indicates all statements below are true.
1. The student identified in Section 1 is registered this term for the courses indicated above, all courses are
nonsectarian in content and are not remedial or developmental.
2. Tenth grade students during their first semester of PSEO participation may take only one Career or Technical
Education (CTE) course.
3. The student has indicated to me the courses above are to be taken for both secondary and postsecondary
credit and all courses above fulfill the student's unmet academic high school graduation requirement(s).
Signature – Postsecondary Institution Contact
Contact Email Address
Date
*SSID stands
for State Student Identification Number (i.e. MARSS Number
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signature
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Page 3
ED-01763-23
2022-23
Postsecondary Enrollment Options (PSEO) Student Eligibility
Minnesota Statutes 2021, sections 124D.68 and 124D.09
Public, Nonpublic and Home School Student Eligibility – 11th or 12th Grade, Minnesota Statutes 2021, section
124D.09, subdivision 4 and 5.
An 11th or 12th
grade pupil enrolled in a Minnesota public, nonpublic, home school or American Indian controlled tribal
contract or grant school eligible for aid under section 124D.83, except a foreign exchange pupil enrolled in a district
under a cultural exchange program, may apply to an eligible postsecondary institution (PSI) to enroll in nonsectarian
courses.
An 11th or 12th
grade pupil
who is not enrolled in a public school district and includes students attending nonpublic
schools and students who are home schooled. A nonpublic or home school student must continue to submit the Letter
of Intent to Continue to Provide Instruction to the resident school superintendent in order to participate in PSEO (even
if the student is beyond age 17).
Public, Nonpublic and Home School Student Eligibility – 10th Grade CTE Pathway, Minnesota Statutes 2021, section
124D.09, subdivision 4 and 5(a).
A 10th grade public, nonpublic or home school student may enroll in one career or technical education course offered
by an eligible institution during the first term of enrollment. A 10th grade student must have received a passing score on
the 8th grade Minnesota Comprehensive Assessment (MCA) in reading as a condition of enrollment.
A current 10th grade pupil who did not take the 8th grade MCA in reading may substitute another reading assessment
accepted by the enrolling PSI. If the 10th grade student received a “C” or better in the career or technical education
course, the institution must allow the student to take additional postsecondary courses at that institution, not to exceed
the limits in subdivision 8.
Career Technical Education (CTE) Course Definition and Payment
• CTE courses do not include Study Skills, First Year Experience, Career Development Skills or College Success
courses.
• For the purpose of PSEO reimbursement for CTE courses taken by 10th grade students, MDE will only pay for
courses that are part of a career and technical education program that is not also included in the Minnesota
Transfer Curriculum.
• A "career or technical course" is a course that is part of a career and technical education program that provides
individuals with coherent, rigorous content aligned with academic standards and relevant technical knowledge and
skills needed to prepare for further education and careers in current and emerging professions and provide
technical skill proficiency, an industry recognized credential, and a certificate, a diploma, or an associate degree.
• The Minnesota Transfer Curriculum consists of general education courses and goal area definitions and
competencies designed for transfer among Minnesota public colleges and universities.
Public School Student Eligibility – 9th or 10th Grade, Minnesota Statutes 2021, section 124D.09, subdivision 5(b).
A 9th or 10th grade pupil enrolled in a district or an American Indian-controlled tribal contract or grant school eligible
for aid under section 124D.83, except a foreign exchange pupil enrolled in a district under a cultural exchange program,
may apply to enroll in nonsectarian courses offered under 124D.83, subdivision 10 courses according to agreements, if:
1. The school district and the eligible PSI providing the course agree to the student’s enrollment; or
2. The course is a world language course currently available to 11th and 12th grade students, and consistent with
section 120B.022 governing world language standards, certificates, and seals.
Academic Year
Early Middle College Program – Minnesota Statutes 2021, section 124D.09, subdivision 9(b).
Fees; Textbooks; Materials – Minnesota Statutes 2021, section 124D.09, subdivision 20.
Participation in High School Activities – Minnesota Statutes 2021, section 124D.09, subdivision 11(a).
Access to Building and Technology – Minnesota Statutes 2021, section 124D.09, subdivisions 11(a) and 11(b).
PSEO Notice of Student Registration ED-01763-23
2022-23
Limit on Participation, Minnesota Statutes 2021, section 124D.09, subdivision 8.
1. A pupil who first enrolls in grade 9 may not enroll in PSEO courses for more than the equivalent of four
academic years.
2. A pupil who first enrolls in grade 10 may not enroll in PSEO courses for more than the equivalent of three
academic years.
3. A pupil who first enrolls in grade 11 may not enroll in PSEO courses for more than the equivalent of two
academic years.
4. A pupil who first enrolls in grade 12 may not enroll in PSEO courses for more than the equivalent of one
academic year.
5. If a pupil in grade 9, 10, 11, or 12 first enrolls in PSEO during the school year, participation shall be reduced
proportionately.
6. If a pupil is in a learning year or other year-round program and begins each grade in the summer session,
summer sessions shall not be counted against the time of participation.
7. If a school district determines a pupil is not on track to graduate, the limit on participation does not apply
to that pupil.
8. A pupil who has graduated from high school cannot participate in a program under this section.
9. A pupil who has completed requirements for graduation but who has not received a diploma may
participate in the program.
For purposes
of determining PSEO
eligibility,
an academic
year is equivalent
to a school year and is defined
as
July 1 through June 30.
An institution
must not enroll secondary pupils, for PSEO purposes, in remedial,
developmental,
or
other courses
that are not college level except when a
student eligible to participate and enrolled in the graduation incentives
program under section 124D.68 enrolls full time in a middle
or early college program designed with a well-
defined pathway to allow the
student to earn a certificate or degree.
All textbooks and
equipment provided to a pupil, and
paid for by the department, are the property
of the pupil’s
PSI. Each pupil is required to return all textbooks and
equipment to the PSI after
the course has ended.
A school district
must allow a student enrolled in a course under this
section
to remain at the
school site during
regular school hours.
A school district must allow a student enrolled in a PSEO course to remain at the school site during regular
school hours. A school district must adopt a policy that provides a student enrolled in PSEO with reasonable
access during regular school hours to a computer and other technology resources the student needs to
complete coursework for a PSEO course.
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Postsecondary Enrollment Options Notice of Student Registration Form (North Hennepin Community College)

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Completed 25 March 2022

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