Fillable Postsecondary Enrollment Options (PSEO) Program Notice of Student (Itasca Community College)

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Postsecondary Enrollment Options (PSEO) Program Notice of Student (Itasca Community College)

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Postsecondary Enrollment Options (PSEO)
Program Notice of Student Registration
2020-21
ED-001763-21
2020-21
Instructions: Complete an enrollment form for each instructional term and postsecondary institution the student attends. Once
Sections 1 and 2 are completely filled out, the next step is to work with the enrolling postsecondary institution to complete
Section 3. Note: Only postsecondary institutions submit this form to the Minnesota Department of Education (MDE).
College Student ID Number:
1. To be Completed and Signed by the Student and Parent/Guardian
Student Name (Last, First, M.I.) Gender Date of Birth (MM/DD/YYYY)
Address City ZIP Code Phone Number
Postsecondary Institution This Term Parent/Guardian Name Address (if different than above)
Public School Students: Minnesota Statutes, section 124D.09, subdivision 7, requires public school students to inform the
district by May 30 of each year of the pupil’s intent to enroll in postsecondary courses during the following school year to
assist the district in planning. A pupil is bound by notifying or not notifying the district by May 30.
Date I/we notified the public school of the intent to participate in PSEO for either semester of the
2020-21 school year.
My signature(s) below indicates that I/we are aware that if I/we have not notified the enrolling district by May 30, 2020,
and the enrolling district has not waived the deadline, I/we may be responsible for the postsecondary costs.
All Students: Minnesota Statutes, section 124D.09, subdivision 6, requires students and parent/guardian sign a statement
indicating they have received PSEO information, are aware counseling services are available and understand PSEO course
responsibilities. We have received the information required under Minnesota Statutes, section 124D.09, and are aware
the student above is enrolling in postsecondary courses.
Student Signature Student Email
Parent/Guardian Signature
(if student is under age 18) Date
Upon completion of Section 1, pass this form to the pupil’s secondary school for completion of Section 2.
2. To be Completed by Secondary/Nonpublic/Home School
Public Nonpublic Home School
Secondary/Nonpublic/Home School Name School Type (Select one)
Public School Student’s
MARSS* Number
Attending School District Name
Attending School District Number
Select student’s grade level during the 2020-21 school year. (Select only one): Grade 10 Grade 11 Grade 12
Note: High school graduates and 21-year-olds are not eligible.
Students may not enroll in PSEO courses in addition to a full high school class load. Does this student have at least one
free class period during the high school day? (Select one) Yes No
Is the above student eligible for program application? (See Page 3 for requirements) (Select one) Yes
No
My signature below certifies the student identified in Section 1 meets the eligibility requirements outlined on Page 3 for
participation in the PSEO program this term, and the information in Section 2 is accurate and applicable. The public school
student has notified the enrolling public school district of intent to enroll by May 30, 2020, or the public school district has
waived the deadline requirements.
Secondary School Contact Name Contact Signature Email Phone Date
M F
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PSEO Notice of Student Registration
Student Name (Last, First, M.I.)
Date of Birth (MM/DD/YYYY) College Student ID Number
3. To be Completed by the Postsecondary Institution
PSI Number City of Postsecondary Institution
Semester 1
Semester 2 Quarter (Qtr) 1 Qtr 2 Qtr 3
Name of Postsecondary Institution (PSI)
Term of planned attendance (Select one)
Postsecondary Institution Contact Name
Email Telephone
Courses Taken for Secondary Credit Course Number Course Credits
Course #1
Course #2
Course #3
Course #4
Course #5
Course #6
Minnesota Statutes, section 124D.09, subdivision 7, requires public school students to inform the district by May 30
of each year of the pupil’s intent to enroll in postsecondary courses during the following school year to assist the
district in planning. A pupil is bound by notifying or not notifying the district by May 30, unless the public school
district has waived the deadline as indicated in Section 2. A public school student who has not met this requirement
is not eligible for PSEO funding.
Minnesota Statutes, section 124D.09, subdivision 5, requires the institution to send written notice to the student and
the student’s school or district. The notice must indicate the course and hours of enrollment of that pupil.
My signature indicates that 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. Tenth grade students during their
first semester of PSEO participation may take only one Career or Technical Education (CTE) course. The student has
indicated to me the courses are to be taken for secondary credit and fulfill the student’s high school graduation
requirements.
Signature – Postsecondary Institution Contact Title Date
*MARSS stands for Minnesota Automated Reporting Student System
ED-01763-21
2020-21
Itasca Community College
0007-25
Grand Rapids
Gina Hass
gina.hass@itascacc.edu
218-322-2320
Gina Hass
SSC
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PSEO Notice of Student Registration ED-01763-21
2020-21
Postsecondary Enrollment Options (PSEO) Student Eligibility
Minnesota Statutes, sections 124D.68 and 124D.09
Public School Student Eligibility – 11
th
- or 12
th
-Grade Pupil, Minnesota Statutes, section 124D.09, subdivision 5.
An 11
th
- or 12
th
-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.
Public School Student Eligibility – 9
th
- or 10
th
-Grade Pupil, Minnesota Statutes, section 124D.09, subdivision 5(b).
A 9
th
- or 10
th
-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 11
th
- and 12
th
-grade students, and
consistent with section 120B.022 governing world language standards, certificates, and seals.
Nonpublic/Home School Student, Alternative Pupil Eligibility – 10th, 11th or 12th Grade Pupil, Minnesota
Statutes, section 124D.09, subdivision 4.
Alternative pupil means a 10
th
(Career or Technical Education (CTE) only), 11
th
, or 12
th
-grade student who is not
enrolled in a public school district and includes students attending nonpublic schools and students who are
home schooled. An alternative pupil must register with the commissioner of education before participating in
the PSEO program.
A 10
th
-grade student qualifies as an alternative pupil if the student: (1) is enrolled in a career or technical
education course offered by an eligible institution; and, (2) received a passing score on the 8
th
grade Minnesota
Comprehensive Assessment, or another reading assessment accepted by the enrolling postsecondary institution.
A career or technical education course must meet the requirements under subdivision 5a. If an alternative pupil
in 10
th
grade receives a grade of "C" or better in the career or technical education course taken under this
subdivision, the postsecondary institution must allow the student to take additional postsecondary courses for
credit at that institution, not to exceed the limits in subdivision 8.
P
ublic School Student CTE Eligibility – 10
th
, 11
th
or 12
th
Grade, Minnesota Statutes, section 124D.09, subdivision 5(a).
A 10
th
, 11
th
or 12
th
-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 enroll in a CTE course offered by a Minnesota state college or university. A 10
th
grade pupil applying to a CTE course must have received a passing score on the 8
th
grade Minnesota
Comprehensive Assessment (MCA) in reading as a condition of enrollment. A current 10
th
-grade pupil who did
not take the 8
th
-grade MCA in reading may substitute another reading assessment accepted by the enrolling PSI.
PSEO Notice of Student Registration ED-01763-21
2020-21
Limit on Participation, Minnesota Statutes, 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
ac
ademic 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.
Academic Year
For purposes of determining PSEO eligibility, an academic year is equivalent to a school year and is defined as
July 1 through June 30.
Early Middle College Program – Minnesota Statutes, section 124D.09, subdivision 9(b).
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.
Fees; Textbooks; Materials – Minnesota Statutes, section 124D.09, subdivision 20.
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.
Participation in High School Activities – Minnesota Statutes, section 124D.09, subdivision 11(a).
A school district must allow a student enrolled in a course under this section to remain at the school site during
regular school hours.
Access to Building and Technology – Minnesota Statutes, section 124D.09, subdivisions 11(a) and 11(b).
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 (PSEO) Program Notice of Student (Itasca Community College)

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Completed 18 September 2020

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