This section to be completed by high school counselor.
This form must be completed and returned to Terra State with the most current,
unofcial high school transcript before student’s enrollment will be approved.
Applicant’s current high school cumulative GPA
Applicant’s SSID (REQUIRED):
Where does Applicant intend to take classes?
List courses applicant is interested in completing at Terra State Community College
Course Preference List
I verify the above information to be accurate to the best of my knowledge.
Signature of High School Counselor
Signature of Applicant
Signature of Custodial Parent/Guardian
Parent Email (this email will be only used by CCP Advisors for communication and updates)
The applicant and parent/guardian verify that the information given above is complete and accurate to the best of their knowledge.
The applicant gives permission to the College to release academic information, orally or in the form of written record, concerning their
enrollment, grades, schedule, attendance, and behavioral conduct to high school personnel and parents/guardians.
I agree to abide by all policies, regulations, and procedures of the College, including contacting guidance counselors and College
advisors to process any scheduling and/or academic changes.
High School Graduation Requirement (yes/no)
(This will be conrmed with the submission of an unofcial transcript from the high school)
On Campus Online Both At local school (if applicable)
Has Applicant taken the ACT?
(If yes, please include a copy of their scores with the application)
Yes No
Name School Year
Last First Middle Initial
Applicant is:
A continuing (returning) College Credit Plus student
A new College Credit Plus student
Local School:
Tech Prep (if applicable):
Senior Freshman 8
Applicant’s class status for the year they plan to participate in College Credit Plus
School Consent Form
Terra State Community College
10 .0 8.18
Junior Sophomore 7
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