01_CA/PA_Summer ONLY (starting Summer 2025)

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Dual Enrollment Office

COURSE APPROVAL FORM

Summer 2025

Student Information (MUST match the information on your Jefferson State Application)

First Name:

Last Name:

E-mail:

Date of Birth:

(MM/DD/YYYY)

A-number:

(If known)

High School and Term Information

High School:

Grade Completing In May 2025:

Summer 2025 Course Requests

Online or JSCC Campus Course 1

Course Subject

Course Number

Campus

Would you like to add an additional course to your Summer 2025 schedule?

Yes

Online or JSCC Campus Course 2

Course Subject

Course Number

Campus

Would you like to add an additional course to your Summer 2025 schedule?

Yes

Online or JSCC Campus Course 3

Course Subject

Course Number

Campus

Would you like to add an additional course to your Summer 2025 schedule?

Yes

Online or JSCC Campus Course 4

Course Subject

Course Number

Campus

Would you like to add an additional course to your Fall 2025 schedule?

Yes

Online or JSCC Campus Course 5

Course Subject

Course Number

Campus

Important Information Regarding Dual Enrollment Participation

Check each statement to indicate that you have read and understand the information presented.

Release of Records to the Secondary Institution

Check the statement to indicate that you have read and understand the information presented.

As a participant in the Dual Enrollment for Dual Credit program, I understand that it is the responsibility of Jefferson State Community College to release my academic information to my high school and/or secondary educational entity. In signing this form, I authorize the College to release the information noted in this section.

It is the policy of the Alabama Community College System and Jefferson State Community College, a postsecondary institution under its control, that no person shall, on the grounds of race, color, disability, sex, religion, creed, national origin, age, ethnicity, genetic information, marital status, veteran status, pregnancy, sexual orientation, or gender identity/expression be excluded from participation in, be denied benefit of, or be subjected to discrimination under any program, activity, or employment.

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