Concurrent Enrollment Program Parental Consent Form

Arkansas State University

CEP Parental Consent Form

Please complete and submit this Parental Consent Form by the 5^th day of A-State classes. Failure to complete this form will result in the student being removed from concurrent course(s) and placed in another class as determined by the high school counselor and the student.

I. Student Information

High School

Please enter your full name:

Please enter your A-State Student ID (if known):

Please enter your birth date in the following format: month-day-year, with two digits for the month, two digits for the day, and two digits for the year, must include dashes (example: 04-17-98)

What YEAR will you graduate high school?

Please enter your mailing address:

State

Please enter your contact information:

Race/ Ethnicity, Please check one (for statistical use only):

American Indian/Alaskan Native Asian Hispanic/Latino Native Hawaiian/Asian Pacific Islander

Black/African American White Two or More Races Decline to Respond

II. Other information and statements

Are you a First Generation College Bound Student (this means that neither of your parents have graduated from college)?

No Yes

Is English the main language spoken in your home?

No Yes

Parents/Guardians: Please read each section below and sign the consent statement at the bottom of this form to certify that you have read and agree to follow Arkansas State University's policies and procedures regarding your student's enrollment in the A-State Concurrent Enrollment Program.

ACADEMIC ENROLLMENT RECORDS

Student academic enrollment records required for admission and enrollment in the Concurrent Enrollment Program will be obtained from either the designated high school or the Arkansas Department of Education database.

ENROLLMENT

Enrollment in concurrent courses is recognized as enrollment at Arkansas State University. All academic policies and deadlines in effect for the university must be adhered to by the concurrent high school student. These policies and deadlines are available for review in the A-State Undergraduate Bulletin. To locate this information, go to https://www.astate.edu/a/registrar/students/bulletins/index.dot and select the appropriate bulletin year.
Students achieving the required score on the Advance Placement Subject Exam for college credit may choose to enroll in the corresponding concurrent course; however, transcript grades cannot be altered after the concurrent course is completed regardless of AP test scores. The student MUST contact Sharon McDaniel at smcdaniel@astate.edu or (870) 972-3671 for permission to enroll for courses already credited by the AP Exam.
An official course drop must be initiated at the high school counselor's office and the appropriate paperwork completed and submitted to the A-State Concurrent Enrollment Program. Please be aware of the final drop date for each semester. The official academic calendar is available on the A-State Academic Affairs and Research home page. To locate this information, go to https://www.astate.edu/a/academic-affairs-and-research/, look for Academic Calendars on the left side of the page, then click on the appropriate calendar.

FERPA

The Family Educational Rights and Privacy Act of 1974 (FERPA), dealing with the protection of the right of privacy for students, governs access to and release of student records. No one outside the University should have access to a student's education records without the written consent of the student, except officials of other institutions in which a student seeks to enroll, financial aid representatives, accrediting agencies, in compliance with a judicial order, in emergency situations to protect the health and safety of the student or other persons, those designated school officials, within and outside the University, with a legitimate educational interest to access the records, and where disclosure is permitted by FERPA and the Arkansas State University System Policy on the Family Educational Rights and Privacy Act.
Concurrent enrollment students must consent to the release of their records to other parties in accordance with the Arkansas State University System Policy on the Family Educational Rights and Privacy Act. Parents of dependent students may establish eligibility for access to records by presenting proof that section 152 of the Internal Revenue Code of 1954 has been satisfied.

TUITION CHARGES AND PAYMENT INFORMATION

Concurrent students have a one-time application fee which is transferred to the tuition statement. A tuition bill is not generated until the student is enrolled in courses. Concurrent course tuition is greatly reduced from standard tuition rates. For academic year 2019 - 2020, concurrent tuition is $40 per credit hour, and most classes are three hour courses or $120. Tuition rates are subject to change based on policy as established by the A-State Board of Trustees.
Tuition statements must be accessed using the "my.AState" portal on the A-State home page. Students can also add a parent/guardian as an authorized user so the parent/guardian can make payments on their behalf. Directions for accessing this information is available on the A-State CEP webpage, located at https://www.astate.edu/concurrent/.
Students are required to pay tuition unless the A-State course is officially dropped by the 5th day of A-State classes.
Students with outstanding balances will not be permitted to register for future courses or receive a college transcript.
The tuition refund policy is available for review in the A-State Undergraduate Bulletin. To locate this information, go to https://www.astate.edu/a/registrar/students/bulletins/index.dot and select the appropriate bulletin year.

CONSENT STATEMENT

I, , am the parent/guardian of , a student at High School, hereafter referred to as the "High School". I hereby consent for my child to participate in the Arkansas State University Concurrent Enrollment Program, which may begin at the start of my student’s 9th grade year of high school and shall terminate upon my student’s receipt of his/her high school diploma. I hereby certify that I have read and agree to the above notifications concerning my student’s enrollment in concurrent courses offered in partnership between the High School and Arkansas State University. I agree that my student may enroll in concurrent course(s) as recommended by the high school counselor each academic semester, and agree to be held financially responsible for all costs associated with this enrollment and ensure prompt payment is made for these course(s). Additionally, I acknowledge that failure to do so will result in the account being submitted to a collection agency for payment.

I understand and agree that my electronic signature to this consent form shall be given the same force and effect as my handwritten signature, and affirmatively state that I have the legal authority to enter into this agreement on behalf of my child.

I, , a student at High School grant Arkansas State University permission to release information to the parent(s)/guardian(s) whose name and signature appears above, thereby waiving my rights to privacy under the Family Educational Rights and Privacy Act (FERPA). I understand that in order to be dropped from a concurrent enrollment course, the request must be made to my high school counselor and submitted to the Astate Concurrent Enrollment office before the official drop deadline.