Cooperative Alliance Recommendation and Consent Form - EOC Tech Center

              Cooperative Alliance Recommendation
and Consent Form
Alliance College Credit Eligibility
In order to be eligible to enroll for Alliance college credit courses, high school students must meet the following:
 Submit an ACT score of 19 or ACT PLAN score of 15, or an overall high school GPA of 2.5(4.0 scale)
 Submit this form signed by the student’s counselor and parent or guardian and the student
 Submit a current official high school transcript
 Submit official transcripts from any other colleges attended
Once admitted the student must maintain a 2.0 GPA in their college level courses to remain in good standing and
to continue their enrollment in future semesters at Rose State College.
STUDENT NAME__________________________________________________________________
STREET ADDRESS_________________________________________________________________
CITY____________________________________STATE_______________ZIP CODE___________
HOME TELEPHONE (_______)_______________TECH CENTER __________________________
CURRENT GRADE IN SCHOOL ___________ ID NUMBER ______________________________
________ACT COMPOSITE SCORE
________ACT PLAN SCORE
________HIGH SCHOOL GPA
TECHNOLOGY CENTER COUNSELOR NAME (PRINT)_________________________________
COUNSELOR SIGNATURE ________________________________________________________
DATE____________________________________________________________________________
When a student has enrolled in a Rose State College course, the grade issued at the end of the course will become
a part of the student’s official transcript at RSC and is a permanent academic record. Courses transcripted by
RSC are eligible for transfer to other colleges. However, the receiving college has the authority to determine
eligibility of those courses as they apply toward a specific desired major. Once a student is officially enrolled in a
college course, the student must complete the drop/withdrawal process within the designated time frame in
order for the grade not to show up on the permanent official transcript or for any possible refund of payment.
The student must withdraw by visiting the Rose State College Office of Admissions and Records.
I have read and understand the above information, policies and guidelines. As parent/guardian, my signature authorizes
my consent for ______________________________(student name) to participate in this opportunity.
Name of Parent/Guardian (printed)___________________________________________________________________
Home Address_______________________________________________________Phone Number________________
Parent/Guardian
Signature__________________________________________________________________Date_________________
Student
Signature__________________________________________________________________Date_________________
ROSE STATE COLLEGE CERTIFICATION -- OFFICE USE ONLY
QUALIFYING ACT SCORE: ACT PLAN SCORE: HIGH SCHOOL GPA:
IS THE STUDENT CLEARED FOR
ENROLLMENT?
NUMBER OF HOURS ALLOWED: CLEARED BY: DATE:
YES NO
REV.6/20/2008