2025-2026 Dual Credit Registration

DUAL-CREDIT APPLICATION FORM

2025-2026 School Year
This dual-credit program is a partnership between Lakeland College and School of Hope.

Michel Despins

School of Hope

5212 Railway Ave, Vermilion, AB T9W 1C2

Phone: 780-853-2188

Email: michel.despins@ecacs16.ab.ca

Please fill in all data legibly so that your application process is not delayed.
School Information:
School Division*
School Name*
School Mailing Address*
Dual Credit Contact*
Dual Credit Contact Phone*
Dual Credit Contact Email*
example@example.com
Student Information:

Please print your full name as indicated. If you change your name you must notify Lakeland College’s Student Services office.
Name*

Students Legal First NameStudent’s Legal Middle NameStudent’s Legal Last Name
Alberta Student Number
Gender:*

MaleFemaleX-Unspecified
Birth Date*

MonthDayYear
Date
Current Grade*
Address*

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Province*
Postal Code*
Phone*
Cell
School Email*
example@example.com
Voluntary Disclosure:
Do you have an Individualized Education Plan (IEP) or learning condition which may require special assistance?

YesNo
If Yes, please attach your IEP documentation for review to determine eligibility for support.
File Upload

Cancelof
Course Selection:

**PLEASE NOTE: You can only select two dual credit courses per academic year. One per semester.
Semester 1
Please indicate the dual-credit course for which you are applying for Semester 1:

American Sign Language I Part ABasic Energy PrinciplesHairstyling (Safety, Personal Professional Development/Facility & Equipment)Health, Safety and NutritionIntroduction to EstheticsIntroduction to Heavy Oil and GasPlayGIS and Remote Sensing (Drone prep)The Human Body, Health and Chronic Illness
Semester 2
Please indicate the dual-credit course for which you are applying for Semester 2:

American Sign Language I Part ABasic Energy PrinciplesHairstyling (Safety, Personal Professional Development/Facility & Equipment)Health, Safety and NutritionIntroduction to EstheticsIntroduction to Heavy Oil and GasPlayGIS and Remote Sensing (Drone Prep)The Human Body, Health and Chronic Illness
Please read this section completely before initialing and signing.

Freedom of Information and Protection of Privacy:

Lakeland College complies with the Freedom of Information/Protection of Privacy legislation of the Province of Alberta. Information collected on application forms is used in the normal course of college operation in accordance with this legislation.

I declare that the information contained in this application is complete and correct. I agree to abide by the rules and regulations of the school district and Lakeland College. I understand that information about my registration and course progress will be shared by the school district and Lakeland College. I understand that this application does not guarantee admission to Lakeland College programs and is subject to the availability of seats. I understand that this is a school district partnership program and agree that the school district and college reserves the right to modify the program without notice or prejudice.
Student Name*
Student Signature*

Clear
Date*

MonthDayYear
Date
Parent Name or Legal Guardian*
Parent Name or Legal Guardian*

Clear
Date*

MonthDayYear
Date
DUAL-CREDIT AGREEMENT
PART 1 - STUDENT

By signing this agreement, I acknowledge my understanding that I am enrolled in a college-level course and that my work will be graded according to the same standards applied to college students. I understand that the final grade earned in this course will be entered into my permanent record at Lakeland College. As a Lakeland College dual credit student I understand and agree to the following:
- Attend classes and be punctual. Your instructor must be contacted if you will be absent or late.
- Attend all classes as scheduled. Your class schedule will be available from your instructor.
- Meet program homework and study expectations
I understand that I may withdraw from college at any time by submitting a completed Cancellation of Registration/Withdrawal from College form and submitting it to the Office of the Registrar at Lakeland College. A “W grade will be assigned to the course in the current registration period providing the deadline to withdraw has not passed (generally the five-eighths point of the course Withdrawals processed past the deadline to withdraw from courses will result in a failing grade.

In signing this application, I agree to abide by the regulations governing study with Lakeland College. I understand that I can access the full listing of policies and procedures at www.lakelandcollege.ca.
Student Name*
Student Signature*

Clear
Date*

MonthDayYear
Date
PART 2 - PARENT/GUARDIAN

Your son or daughter has expressed an interest in taking a Lakeland College dual-credit as part of their high school program. If accepted into the course, he/she will receive credit for both the College course and will also receive high school credit in CTS (Career and Technology Studies) courses. Students will receive detailed course information from their instructor following their acceptance and registration in the course.

I authorize my child’s participation as a Lakeland College student in dual-credit course offerings. I give permission for Lakeland College to share marks with the school, so that the school may report as per high school reporting requirements.
Print Name/Parent/Guardian*
Signature/Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Should be Empty:

DUAL-CREDIT APPLICATION FORM

School Information:

Voluntary Disclosure:

Semester 1

Semester 2

DUAL-CREDIT AGREEMENT