Revised 04/2015
Workforce and Professional Development
High School Concurrent Enrollment Approval Form
(This form must be completed for each student and for each attended class.)
Name of Student: Age: Birth Date: ___/___/___
Last First Middle (Must be 16 years old) M D Y
Grade Level: High School: Is this a home school? ___No ___ Yes
Class Title: Section #: Class Date: Class Hours:
I certify that the student listed above is in good academic standing and is making satisfactory academic progress toward graduation.
Approval (signature) of Principal/Counselor Date
Permission to register for an on-line course
Approval (signature) of Principal/Counselor Date
Western Piedmont Community College has permission to release my transcript and/or educational records to my parents and/or the high school I am
attending during my enrollment as a concurrent enrolled student.
Student Signature Date
Approval (signature) of Director of Records & Registration (or designee) Date