Student Dual Enrollment Information

Student Name*

First NameMiddle NameLast Name

Student Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Student Date of Birth*

MonthDayYear

MCC Student ID Number*

Your MCC student number is emailed to you after you are accepted. If you do not have a student number, please do not complete this form until you do.

High School*

Please remove the word "homeschool" and fill in your parent's email in the high school counselor's email box.

Please fill in your high school's name and your counselor's email address below.

Unlisted High School Name*

High School Counselor's Email*

example@example.com

Select your high school counselor for Allendale Public School*

Jason FogelLaura Vandyke

Select your high school counselor for Fremont High School*

Tressa WenkSteve Mull

Select your high school counselor for Grand Haven High School*

Amanda DavidsAngie PrieditisKeith WilliamsKim Kowalski

Select your high school counselor for Mona Shores High School*

Amorette ClausenDanielle Smith-WalkerStacie Meyers

Select your high school counselor for Muskegon High School*

Jennifer O'BrienShawndra Sain

Select your high school counselor for Oakridge High School*

Bayley FeltKurt Kiesgen

Select your high school counselor for Orchard View High School*

Clara MooreJessica Lazar

Select your high school counselor for Sparta High School*

Blake SchanskiTeresa Converse

Select your high school counselor for Spring Lake High School*

Ann HenkeJulia SmithNaomi Vansingel

Select your high school counselor for Whitehall High School*

Carrie GoodrichDerek Westerlund

Parent/Guardian Name*

First NameLast Name

YOUR PARENT/GUARDIAN'S EMAIL ADDRESS CANNOT BE THE SAME AS YOUR EMAIL ADDRESS.

Parent/Guardian Email*

example@example.com

Expected Graduation Year*

Student Release Authorization

Students are responsible for managing their enrollment at MCC. This form is for course approval and tuition authorization only. Students will need to register themselves for all courses at MCC. I agree that registration is contingent upon timely completion of all requirements and available open seats in the course(s) selected. The college's course schedule is tentative and may change, including canceled sections, added sections, faculty changes, and textbook changes. I agree to become knowledgeable about MCC's rules and regulations and abide by them. I understand that course transferability varies by institution, and that it is therefore my responsibility to check with the receiving institution to see if my credits will transfer. MCC may release my academic records to my high school, including but not limited to: course progress, attendance, and final course grade(s I understand that MCC faculty and staff are not able to release or discuss academic information with my parents/legal guardians without submitting a Family Education Rights and Privacy Act (FERPA) Release Form to MCC's Registrar's Offices.

I understand that I am responsible for ALL tuition and charges related to attending MCC if a course is not approved by the school district. I understand that I will be responsible for ALL tuition and charges related to attending MCC if I drop a course AFTER the 100% drop deadline date. I understand that I must discuss any changes made to my schedule with my high school counselor prior to making them (including adding and dropping classes.

Please sign and date below if you agree.

Student Signature*

Today's Date

MonthDayYear

Public or Non-Public School*

PublicNon-Public

Student UIC #

Non-Public Schools Only

Semester*

Academic Year*

Please use the full 4 digit year (i.e. 2024).

Complete By Counselor - Please check the section(s) that applies to the applicant*

Michigan Dual Enrollment: The student is eligible for Dual Enrollment. The school district will pay its portion of tuition and fees to Muskegon Community College. Any tuition or fees beyond the school's dual enrollment allotment will be billed directly to the student and family by Muskegon Community College.High School will cover the cost of textbooks up frontHigh School will reimburse students for the cost of textbooksHigh School will cover the cost of Art supplies needed for classSelf-Pay High School Guest (Student/Parent/Guardian paying)

List of Registered Classes for Current Semester or Notes from high school counselor:*

List of Registered Classes for Current Semester or Notes from high school counselor:

High School Authorization Section - This section needs to be completed by the high school if they are covering the cost.

The above student is currently enrolled at our high school and has been approved to register for Muskegon Community College courses. The high school will pay MCC for the tuition and fees (as well as books if indicated above).This form is for dual enrollment approval and tuition authorization only. Students will need to register themselves separately.

By signing this form, you are indicating that a designated school district representative has discussed course selection, tuition, fees, and book responsibility for courses covered and not covered; as well as the penalty for dropping courses after the 100% drop deadline with the student.

The following registered course(s) will NOT be covered by the high school for selected semester

(i.e., Please list any class(s) the student will register for and the high school will NOT cover. If there are not any, please leave blank)

Counselor Signature*

Parent/Guardian Information and Release

I understand that my child intends to enroll in a college course. I understand that my student will be required to meet all attendance and classroom participation requirements expected of a college student. My student and I agree to become familiar with college policies covering course withdrawal, tuition refunds, class attendance and campus standards of conduct outlined in the MCC catalog. I understand that information regarding my child's course progress, attendance, and final grade(s) will be shared with the principal or counselor of his or her high school upon the school's request in accordance with the Family Educational Rights and Privacy Act Regulations (FERPA). I understand that MCC faculty and staff are not able to release or discuss academic information with parents/legal guardians without submitting a FERPA Release Form to MCC's Registrar's Offices.

By signing below, I am indicating that I understand that my child is responsible for ALL tuition and charges related to attending MCC if a course is not approved by the school district. I understand that my child will be responsible for ALL tuition and charges related to attending MCC if they drop a course AFTER the 100% drop deadline date. I understand that my child must discuss any changes made to their schedule with their high school counselor prior to making them.

Parent/Guardian Signature

Student Dual Enrollment Information

Counselor Information

Parent/Guardian Portion