877.332.8682
Zell Miller Eligibility Waiver Agreement for Dual Enrollment 10
th
Graders
*This Agreement is for 10
th
grade students only, who are seeking to use Zell Miller Eligibility in order to
participate in Dual Enrollment and receive Dual Enrollment Funding as a 10
th
grade student.*
I acknowledge that my student, ________________________ (Student Name), who attends
___________________________________ (High School Name), will be permitted to enroll in Dual
Enrollment courses at Coastal Pines Technical College without submitting an ACT or SAT score. Due to
the COVID-19 public health emergency, I understand that my student has until December 30, 2020, to
obtain and turn into GSFC and Coastal Pines Technical College an official copy of the qualifying ACT or
SAT scores required to enroll in Dual Enrollment courses.
I agree to pay all tuition, mandatory fees, and book costs out-of-pocket in order to enroll my student in
Dual Enrollment courses for the 2020-2021 academic year. Upon my student obtaining a qualifying ACT
or SAT score, I acknowledge that I must apply to Coastal Pines Technical College for reimbursement of
these payments (excluding any expenses and costs which are not covered by the Dual Enrollment
Funding Program). If my student does not receive a qualifying ACT or SAT score by December 30, 2020, I
acknowledge that I will not receive a reimbursement payment.
As the parent/guardian of the above named student, my signature on this waiver certifies that I have
read, understood, and accepted the risks involved with making such payments. I agree to hold harmless
and expressly waive any legal claims that could otherwise be made to Coastal Pines Technical College or
the Technical College System of Georgia with regard to not receiving a reimbursement payment for the
out-of-pocket costs incurred to enroll my student in Dual Enrollment courses.
PARENT/GUARDIAN
_______________________________________ __________________________
Parent/Guardian Name (PRINTED) Date
________________________________________________________
Parent/Guardian Signature
*Once this form has been completed, please submit to your Coastal Pines Technical College
High School Coordinator or submit via email to dualenrollment@coastalpines.edu.*
click to sign
signature
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