State of New Mexico Estado de Nuevo México Logo
Language
  • English (US)
  • Spanish (Latin America)

  • Please select in the top right corner to view this form in English or Spanish.

    Por favor seleccione en la esquina superior derecha para ver este formulario en inglés o español.

  • State of New Mexico

    Dual Credit Request Form
  •  - -

  • Agreement of Parties

    Through the submission of this form, you will have also acknowledged that you agree to this agreement.

  •  

    1. STUDENT & PARENT. Endorsement of the Dual Credit Form by the STUDENT and PARENT, unless the STUDENT is 18 years old, shall be evidence that they possess an awareness of, and agree with the following provisions. For purposes of this agreement, Local Education Agency (LEA) means public school districts, state chartered charter schools, state-supported schools and Bureau of Indian Education-funded high schools.

    1. Admission and Enrollment of Students. For a student to be accepted and enrolled into a dual credit program, the STUDENT shall:

    a. Discuss potential dual credit courses with the appropriate LEA and POSTSECONDARY INSTITUTION staff. This discussion shall include POSTSECONDARY INSTITUTION admission and registration requirements, course requirements, credits to be attempted, congruence with student Next Step Plan, credits to be awarded, scheduling under dual credit, and implications for failure to successfully complete the course;

    b.Obtain course requirements for each course, including course prerequisites, course content, grading policy, attendance requirements, course completion requirements, performance standards, and other related course information;

    c. Meet the prerequisites and requirements of the course(s) to be taken;

    d. Complete this Dual Credit Request Form available online or in hard copy from the LEA or POSTSECONDARY INSTITUTION;

    e. Return this Dual Credit Request Form with the specific courses requested, required signatures and, if applicable, a current high school transcript, and copies of either Compass or Accuplacer assessment results to an LEA representative;

    f. Obtain approval for enrolling in the dual credit program each semester by acquiring all necessary signatures on the Dual Credit Request Form and submitting this form to a POSTSECONDARY INSTITUTION representative;

    g. Register for courses during the POSTSECONDARY INSTITUTION’s standard registration periods (NOTE: enrollments shall not be permitted after the close of posted late registration);

    h. Discuss any request for a change in registration (add, drop, withdrawal), recognizing that “audit” is not allowed for a dual credit course, and complete all necessary forms and procedures with appropriate LEA and POSTSECONDARY INSTITUTION staff; and

    i. Comply with POSTSECONDARY INSTITUTION and LEA student codes of conduct and other institutional policies.

    2. Rights and Privileges of Student. The right and privileges of STUDENTS participating in Dual Credit include:

    a. The rights and privileges equal to those extended to LEA and POSTSECONDARY INSTITUTION students, unless otherwise excluded by any section of this Agreement;

    b. The use of POSTSECONDARY INSTITUTION library, course related labs and other instructional facilities, use of POSTSECONDARY INSTITUTION programs and services such as counseling, tutoring, advising, and special services for the students with disabilities, and access to POSTSECONDARY INSTITUTION personnel and resources as required; and

    c. The right to appeal, in writing to LEA or POSTSECONDARY INSTITUTION, as applicable, any decision pertaining to enrollment in the dual credit program.

    3. Financial Responsibility for Funding Dual Credit. The STUDENT shall:

    a. Return the textbooks and unused course supplies to LEA when the student completes the course or withdraws from the course;

    b. Arrange transportation to the site of the dual credit course. Depending upon the time and course location, the student may have access to transportation through LEA if the dual credit course is offered during the school day; and

    c. Be responsible for course-specific (e.g. lab, computer) fees.

    4. Confidentiality of Student Records.

    a. Student educational records created as a result of this Agreement shall be retained and disseminated in accordance with FERPA requirements;

    b. Participation in dual credit courses requires STUDENT and/or PARENT/GUARDIAN signatures on this Dual Credit Request Form to comply with FERPA regulations.

    5. Secondary School and Postsecondary Institution Calendars.

    The regular operating institutional calendar and schedule of POSTSECONDARY INSTITUTION shall be observed by STUDENTS earning dual credit. Dual credit STUDENTSare required to comply with the requirements of both LEA and POSTSECONDARY INSTITUTION official calendars. In instances in which the calendars are incongruent, the dual credit STUDENT is required to independently satisfy both calendar requirements and may consult with school counselors for assistance.

    B. LEA. Endorsement of this Dual Credit Request Form shall be evidence the LEA has and will comply with the provisions outlined in the Agreement between the POSTSECONDARY INSTITUTION and the LEA.

    C. POSTSECONDARY INSTITUTION. Endorsement of this Dual Credit Request Form by the POSTSECONDARY INSTITUTION shall be evidence that the POSTSECONDARYINSTITUTION has and will comply with the provisions outlined in the Memorandum of Agreement between the LEA and the POSTSECONDARY INSTITUTION.

     

     

    Rev. 10/21

  • Student Information

  • Course Listing and Secondary/Postsecondary Approval

    The above-named student has been given permission to enroll as a dual credit student. Based on this student’s Next Step Plan, academic record and overall maturity, I feel he/she will be successful in college level courses. Therefore, as a high school representative, I recommend the student take the following course(s).

  • For students in "Good Academic" status

    When a dual or concurrent enrolled student elects to take more than 18 credit hours per semester and is in "Good Standing" academically with WNMU, a Petition for Overload will be required. Petitions for Overload will be required at the time of registration through the JotForm process. If a Petition for Overload is not submitted, the student will ONLY be registered for 18 credit hours in the order the courses are listed on the JotForm and a new JotForm with the petition will be required for the remaining credit hours.

    For students in "Probation" status

    When a dual or concurrent enrolled student is on academic probation with WNMU, and the student elects to take more than 13 credit hours per semester, a Petition for Overload will be required. Petitions for Overload will be required at the time of registration through the JotForm process. If a Petition for Overload is not submitted, the student will ONLY be registered for 13 credit hours in the order the courses are listed on the JotForm and a new JotForm with the petition will be required for the remaining credit hours.

    Click Here for Petition for Overload Form

     

  •  

  • FERPA Release Information

    Through the submission of this form, you will have also acknowledged that you agree to this agreement.

  • We, the student and parent/guardian, agree for the above-named student to enroll in the Dual Credit Program offered in coordination with the above named high school and postsecondary institutions.

    We understand the high school representative will authorize course selection for each term.

    We understand that all prerequisite requirements, including assessment and course placement must be met. We agree to abide by the guidelines in the Dual Credit Memorandum of Agreement, and in high school and postsecondary policies and codes of conduct.

    We will cooperate with both the high school and postsecondary institution in fulfilling student responsibilities.

    We understand that any courses registered for, or grades earned, become a permanent part of the student’s high school and college record. At the end of each quarter and/or semester, we authorize the postsecondary institution to send all grades to the high school, including those for courses that are not a part of this agreement. We understand that it is the student’s responsibility to receive approval from the high school representative for permission to drop or withdraw from the course(s) listed above.

    According to the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), all rights of access to student educational records transfer from parent to student when the student is enrolled in a postsecondary institution. Accordingly, dual credit students still enrolled in high school have rights of access to their postsecondary dual credit records. In order for the student to receive credit, transcripts of dual credit courses will be shared among the secondary and postsecondary institution, the New Mexico Public Education and Higher Education Departments (NMPED/NMHED). The parent/guardian signature authorizes the assignment of a STARS ID to the student enrolling in a dual credit course(s).

    All data will be used and maintained in accordance with all federal and state statutes, regulations, and policies.

    By signing below, I, the student, authorize the postsecondary institution listed above, to release all information concerning my academic records to my high school, the NMPED, and the NMHED. I understand that information may be released orally, electronically, or on paper. I have the right to inspect any written records released pursuant to this consent and understand that I may revoke this consent at any time.

     

     

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Signatures

    We, the student and parent/legal guardian, certify that all the information furnished in this application is true and to the best of our knowledge. We understand that any misrepresentation of the facts may result in the immediate cancellation of the Student's application or registration.
  • Clear

  •  

    Postsecondary Representative(s) Name

    Jennifer Morales

    Dual Enrollment Coordinator
    Western New Mexico University   

    Jessica Enriquez

    Director Graduate Admissions & Outreach Programs
    Western New Mexico University

     

  •
  • Should be Empty: