R42 Special Part-time Attendance Check-Off List
Complete EVC Application
Complete R42 form
1. If you are a middle school student, you must also
A signed letter from your principal supporting your EVC
Provide junior high transcripts
Make an appointment to see Director of
2. If you are a homeschooled student, you must submit:
Verification that you are affiliated with a homeschool
program recognized by your school district or copy of R4
Make an appointment to see Director of
3. If you are a student no longer attending high school and are between 16-18, you must
Verification of GED or High School proficiency results
Provide high school transcripts
Make an appointment to see Director of
San Jose/Evergreen Community College District
Special Part Time Student
Admissions Policy
Evergreen Valley College
San Jose City College
A parent or guardian of a student who is under 18 and is not attending high school may directly petition to the college
to authorize the attendance of the student as a part-time student. Part-time students admitted under these provisions
will be subject to all college rules and regulations which are published in the college catalog. (Educations Code 76001,
District Policy 5000.2)
Part A To be completed by student, parent or guardian
Please PRINT
Name Date
Last First
Student ID Number (EVC)
Date of birth
Current age
Name of last school attended_
Last grade completed
l am:
A middle school student
A homeschooled student ______________________________________
Name of homeschool program
A student who has earned a GED A student who passed the high school proficiency exam
Reasons for wanting to attend college ___________________________________________________
Student’s Signature
Parent or Guardian’s Signature
Part B To be completed by college
Admissions Director
Reason(s) __________________________________
President s Signature _
White: Admissions - Yellow: Counseling - Pink: Student R-42