Dual Credit/Early College Form - John A. Logan College

Legal Name *

First

Last

JALC Student ID or Birth date *

High School *

High School Grade in Fall 2024 *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Best contact email address *

Email

Confirm Email

Parent/Legal Guardian email address *

Email

Confirm Email

Emergency Contact Information:

Emergency Contact Name *

First

Last

Relationship to Emergency Contact *

Emergency Contact Phone number *

Are you Hispanic or Latino/Latina?

Yes
No

Please select your primary racial/ethic group.

If you are multi-racial, please select all categories that apply.

I am requesting the following outreach from the Dual Credit Office *

Registering For *

If you chose "I would like a Zoom call or in-person meeting to discuss registration options." Please list what days and times work best for you.

Course Registration: If you know which course(s) you would like to take, please list them below. If you would like to discuss your options, leave this blank until your advisement meeting.

Expected College Major or Future Plans

Are you planning to make significant progress towards an Associate’s degree prior to high school graduation? *

Yes
No

If yes, we will be reaching out to you to discuss your registration and help you with a curriculum plan. Please be on the lookout for an email from our office to schedule a meeting with you.

Please read and check the following statements to indicate your agreement

Statement 1 *

I understand that I am responsible for paying all tuition in excess of 8 credit hours and all fee charges by the posted due date.

Statement 2 *

I understand that I must contact the Dual Credit Office or my guidance counselor to make any schedule changes.

Statement 3 *

I understand that I am subject to all privileges and policies in the Dual Credit Student Handbook.

Statement 4 *

I understand that grades for my dual credit courses are recorded permanently on my John A. Logan transcript and that performance in dual credit courses may have implications on future financial aid eligibility. See the Dual Credit Student Handbook on the JALC website for additional information.

Statement 5 *

Some courses may have content that is graphic, violent, or mature in nature; however, this content is directly related to the course curriculum. Please discuss any questions or concerns about exposure to sensitive material with the course instructor.

Statement 6 *

I waive my right to privacy under FERPA and grant John A. Logan College officials permission to share information regarding my performance with my parents, legal guardians and/or high school personnel.

Student Digital Signature (Please type your name and today's date to acknowledge your registration) *

If you have any additional questions, comments, or information you would like to pass along to us please include it here