Supplemental Application and Certification of Special Part-Time High School Diploma Student

High School Coordinator Check List

LEGEND:

Completed by Student

Completed by Principal/Vice Principal of High School

Completed by Parent/Guardian

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Supplemental Application and Certification of Special Part-Time High School Diploma Student

High School Coordinator Check List

MANDATORY:
ð  Student completed college application. Obtain City College CSID# from student. If student does not remember City College CSID#, obtain SS# from student.
COMPLETING THE SUPPLEMENTAL APPLICATION AND CERTIFICATION OF SPECIAL PART-TIME HIGH SCHOOL DIPLOMA STUDENT (also known as: YELLOW HIGH SCHOOL) FORM:
ð  Pg. 1: Student completed the left margin information.
ð  Pg. 1: Student completed top general information.
ð  Pg. 1: Student read and understood the Admissions Regulations and Academic Standing Rules to concurrent high school enrollment and signed and dated in agreement of the regulations and rules presented.
ð  Pg. 1: Student verified with high school officials (Principal, Vice Principal, or High School Counselor) as to the choice of course/courses.
ð  Pg. 1: High School completed the High School Certification.
o  Name of student and name of high school is clearly identified.
o  Appropriate semester and academic year is clearly identified.
o  Course information is fully identified.
o  Principal/Vice Principal printed name, signature, and date of signature is provided.
o  School Telephone is provided.
o  High School Stamp/Seal is present.
ð  Pg 2: Student’s Parent/Guardian completed the Parent/Guardian Permission for Son/Daughter to Enroll in a College Class. Students 18 years or older must have parents complete this section.
o  Name of student is clearly written.
o  Appropriate semester and academic year is identified.
o  Appropriate college is identified.
o  Parent/Guardian printed name, signature, and date of signature is provided.
ð  Pg 2: Student’s Parent/Guardian completed the Minor’s Authorization Consent for Medical Treatment. Students 18 years or older must have parents complete this section.
o  Parent/Guardian read and understood the terms to consent for medical treatment by providing a printed name, signature, and date of signature.
ð  Pg 2: Student completed the Access to Student Records.
o  Student printed his/her full name.
o  Student listed the individuals or agency authorized by the student to access his/her records.
o  Student clearly defined the timeline in which the individuals or agency may have this access to his/her records.
o  Student’s signature and date of signature is provided.

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