Concurrent Authorization Form Submission

High School Concurrent Enrollment Authorization Form
Are you a NEW or RETURNING high school concurrent student?*

NEW (I have NEVER taken concurrent courses at Redlands Community College)RETURNING (I am currently enrolled or have taken concurrent courses at Redlands Community College)
Scroll & review admission requirements before continuing.*
If you are unsure if you meet the admission requirements, you can complete this admittance check:
ADMITTANCE ELIGIBILITY CHECKER
Date*

MonthDayYear
Date
Redlands CC Student ID #:
Student ID Number
Student Name:*

First NameLast Name
Concurrent Enrollment Semester*

Fall 2025
Date of Birth*

MonthDayYear
DOB
Email Address:*
Email
Phone Number:*

Area CodePhone Number
High School:*
Current High School Attending
Expected High School Graduation Date (Month and Year)*
Month and Year
High School Counselor Name*

First NameLast Name
High School Counselor Email*

Confirmation EmailPlease input your high school counselor email address to receive approval for your concurrent enrollment
Redlands Course(s) Desired by Student:*
TO BE COMPLETED BY STUDENT AND PARENT/GUARDIAN (EACH SEMESTER):

We understand that in order to continue enrollment as a high school concurrent student a minimum overall 2.0 college GPA must be maintained.
Parent/Guardian Initial*
Student Initial*
We understand that any schedule adjustment or withdrawal must be approved by the High School Counselor. Failure to withdraw may result in an “F” grade that cannot be removed.
Parent/Guardian Initial*
Student Initial*
Tuition Cost:

-Senior: Concurrent tuition is waived up to 18 credit hours starting the summer semester before senior year.**

-Junior: Concurrent tuition is waived up to 9 credit hours starting the summer semester before junior year. **

**All concurrent students are responsible for the cost of textbooks and any fees associated with their classes (fees for science classes, etc.).

***All NEW concurrent students are responsible for a one-time $25 admission fee.
Parent/Guardian Initial*
Student Initial*
We understand that courses taken for dual credit may affect high school graduation eligibility. If I drop/withdraw from a concurrent course, I must notify my High School Counselor immediately.
Parent/Guardian Initial*
Student Initial*
I have read and understand the provisions set forth by my high school and Redlands Community College for my concurrent enrollment. I give permission for Redlands to release my test scores, grades, attendance information, and Redlands transcripts to my high school and parent/legal guardian for the duration of my concurrent enrollment.
Student Signature*
Parent/Guardian Printed Name:*

First NameLast Name
Parent/Guardian Signature*
FINANCIAL RESPONSIBILITY (REQUIRED TO PROCESS ENROLLMENT):*

First NameLast Name
Social Security Number*
Date of Birth*

MonthDayYear
DOB
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*

Confirmation Email*Email for the person claiming financial responsibility
Verification of Information*
Financial Responsibility Signee Signature*
Redlands CC Advisor Signature

Clear
Redlands CC Registrar Signature

Clear
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High School Concurrent Enrollment Authorization Form