Fillable Special Part-Time Petition for Advanced Admission (Modesto Junior College)

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Special Part-Time Petition for Advanced Admission (Modesto Junior College)

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Special Part-Time Petition for
Advanced Admission
Must be at least 13 years old. A new petition is required each semester.
Please read the following information carefully. Complete the Special Part-Time Petition on the reverse side for
eligibility at MJC.
MJC has an open agreement with local high school districts to enroll high school students in college classes.
Eligibility Requirements
Dual Enrollment students are permitted to enroll in a maximum of 11 units each semester. Enrollment in more than
11 semester units requires approval by the high school principal and MJC designee. Students are now able to enroll in
non-credit and non-degree applicable courses, excluding physical education courses.
To be considered for admittance as a special part-time student, the student must meet the eligibility standards
as established in Education Code Sections 48800 and 76001.
•Meettheacademicprerequisitesforthecourse;includingtherequiredplacementlevelforanymath,reading
or English course.
•AbilitytobenetfromadvancedscholasticorvocationalworkasdeterminedbytheYosemiteCommunity
CollegeGoverningBoard,whichauthorizesthePresident(ordesignee)tomakesuchjudgements.
In order to be approved for future semesters, concurrently enrolled students must be in good academic standing at
MJC(denedashavingacumulative2.0gradepointaverage).ThenumberofW’sinrelationshiptoattemptedunitsis
takenintoconsideration.
Documentation Requirements
In order for high school students to enroll in college courses, the following is required:
•Submitonlinecollegeapplicationforadmission;
•SubmitacompletedSpecialPart-TimePetitionforAdvancedAdmissionformwithsignedparentalor
guardianconsentandprincipalssignature;
•Aparentorguardianofapupilwhoisenrolledinacharter/home-schoolmaypetitiondirectlywithoutthe
signature of a principal and present a copy of the adavit submitted to the State or County Oce of
Educationtodocumentthestudent’sinvolvementinaneducationalprocess.
Studentsenrolledin7thor8thgrademustsubmitaletterofrecommendationsignedbytheirschool’sprincipal.
Upon high school graduation each graduating senior, who enrolled in MJC classes as a high school student,
must reapply as a “high school graduate” online. Failure to do so may delay registration for classes.
Enrollment Fees
MJC will waive the enrollment fees (for California residents established with California Law) of students who enroll as
special part-time. Special full-time students, enrolled in more than 11 units, will be responsible for all enrollment fees
($46 per unit), including out-of-state tuition.
Allstudentsarerequiredtopayapplicablesemesterfeeswhichmayinclude(feesaresubjecttochange):
MJCEnrollmentServices•Phone(209)575-6853
EAST435CollegeAvenue,StudentServicesBldg.1stFloor•WEST2201BlueGumAvenue,YosemiteHall1stFloor
02/2020_SJB
HealthFee-$20Fall&Spring,$17Summer StudentCenterFee-$1perunit
StudentActivityFee-$10(optionalfee) StudentRepFee-$2(optionalfee)
Special Part-Time Petition for
Advanced Admission
Mustbeatleast13yearsold.Anewpetitionisrequiredeachsemester.
Submit completed form in-person to Enrollment Services.
Student Information
FirstName: MiddleInitial: LastName:
MJC Student ID: w Birthdate: Phone:
MJC Student Email:
MailingAddress:
School Information
SchoolName: SchoolPhoneNumber:
SchoolAddress:
CurrentGradeLevel: ExpectedDateofHighSchoolGraduation: Isthisahomeschool?YesNo
PleaseindicateONEterm/year:FALL  SPRING SUMMER
Courses student wishes to enroll in:
Course Name & Number
Units
Course Name & Number
Units
PrincipalorDesignee:PursuanttoEducationCode48800.5and760001,Ihavereviewedtheacademicrecordoftheabovenamed
student and certify that the student demonstrates adequate preparation in the course(s) listed. I certify that I am limiting the
numberofrecommendationstonomorethan5%ofthetotalnumberofpupilswhocompletedthegradeimmediatelypriorto
the time of the recommendation for summer semester.
I certify that I am aware of the above Ed Code and recommend that the above student take no more than units.
Principal/Designee Signature: Date:
Printed Name: Title:
Certication by Parent/Legal Guardian
I certify that I have read the conditions of Dual Enrollment and that the student will only enroll in the courses recommended
aboveandwillnotexceedtheapprovednumberofunits.Weareawareoftheadditionalrequiredfeesandthenon-resident(out-
of-stateinaccordancewithCALaw)tuitionfeesrelatedtothestudentstatus;fees are due upon registration. I understand the
student must reapply to MJC their senior year as a high school graduate.
Parent/Legal Guardian Signature: Date:
Emergency Contact Name: Phone Number:
OFFICE USE ONLY
Sta Initials: Date: PERC: Yes No RES: Yes SB150: Yes GPA: Email:
MJCEnrollmentServices•Phone(209)575-6853
EAST435CollegeAvenue,StudentServicesBldg.1stFloor•WEST2201BlueGumAvenue,YosemiteHall1stFloor
Certication by Principal or Designee
Student Signature: Date:
Street Name & Number City State Zip Code
02/2020_SJB
MODESTO JUNIOR COLLEGE
CONSENT FOR TREATMENT OF MINORS
03/02/20_AY
Anyregisteredstudentundertheageof18willberequiredtohaveaparental/guardianconsentformsigned
before receiving any medical treatment, including mental health services, except in emergencies or cases
exempt by state law.
SignedconsentwillberetainedintheCollege’sHealthServicesOce.
I hereby authorize and give consent for my son or daughter to receive medical treatment, including mental
healthservices,asneeded.Thisauthorizationisgiveninadvanceofanyspecicdiagnosis,treatmentor
medicalcareinaccordancetotheprovisionsofFamilyCodeSection6910-6911.
Forinformationregardingthehealthfee,visitmjc.edu/studentservices/business/tuitionandfees.php
Please indicate which term and year your son or daughter is attending:
Sumer,Year
Fall,Year
Spring,Year
Student’sName(Pleaseprint):
DateofBirth: W#(ifknown):
Parent/GuardianName(pleaseprint):
Parent/GuardianAddress:
Parent/GuardianPhoneNumber:
Signature: Date:
Parent/Guardian
Signature: Date:
Student
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Special Part-Time Petition for Advanced Admission (Modesto Junior College)

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Completed 4 September 2020

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