Counselor Approval Form 2023-24

Date:

CONTACT DETAILS

Student Full Name (required)

Permission for Dual Credit Transfer to a Public School
Name of Public School (required)

School Address (required)

City (required)State (required)Zipcode (required)

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COURSES

Course 1 Title (required)

Course 2 Title

Course 3 Title

Please choose a reason for taking courses

Schedule ConflictCourse Not OfferedGrade ImprovementEnrichmentCredit Recovery

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Counselor Name (required)

Signature:
Date:

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Parent Name (required)

Parent Email (required)

Student Name (required)

Administrator Name (required)

STUDENT ACADEMIC INFORMATION

I am a student seeking D1 and/or D2 eligibilityI am a student that must complete a course within a given timeI am a Senior