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Returning Dual-Credit Student Enrollment Request Form

Please ONLY complete this form if you have previously taken courses with Chadron State. If this will be your first course with CSC, please work with your Counselor to complete the Dual-Credit Admissions Application online.








Which high school do you currently attend and plan to take Dual-Enrollment courses?

*If your school is not listed in the above list, we do not offer Dual-Enrollment courses through your high school. If you wish to take courses at CSC as an Early-Entry student, please contact the office of Market Development at CSC for more information: 308-432-6496 or marketdevelopment@csc.edu.

To be completed by the High School Counselor/Principal:



I certify this student has met at least one of the following requirements to enroll in dual-credit course work.
  • Student had attained a GPA of at least 3.0 (on a 4.0 scale) OR
  • Student earned an ACT composite score of 20 or equivalent score on another standardized test OR
  • Student earned an ACT sub-score of at least 20 or equivalent on another standardized test OR
  • Student ranks in the upper 1/2 of their high school class.


Course(s) Selection

Course # Course Name Credit Hours
Term you wish to take the courses listed above (if requesting enrollment for multiple terms, please complete a request form for each term)
You are qualified for and have applied for the ACE scholarship?

DISCLAIMER:

By submitting this form, you agree to and understand the following:

You have the permission of your parent/guardian to enroll in dual-credit coursework at Chadron State and have the appropriate academic requirements as certified by your Counselor/Principal above.

You understand you and/or your parent/guardian will be required to make payment to the CSC Business Office in the amount of $60 per credit hour if you do not qualify for the ACE scholarship (for example $180 for a 3 credit course) prior to enrollment. Payment can be made over the phone by contacting the Business Office at 308-432-6240 or via your MyCSC account online.

You understand that should you not be approved or granted an ACE scholarship, you are fully responsible for FULL payment of the course.

You understand and agree that you are obligated to reimburse Chadron State College for the ACE Scholarship if I earn a course grade or grades that fall below minimum thresholds as established by CSC ACES grade policies.


I agree and understand the above stated policies and all other policies associated with dual-credit enrollment at Chadron State College.

I agree and understand that by submitting this form, I will be enrolled in the courses requested above by CSC personnel and notified via my EagleMail account.





 

 

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