INTENT TO PARTICIPATE IN COLLEGE CREDIT PLUS

ACADEMIC YEAR 2021-2022: PUBLIC SCHOOLS

Date
After April 1, you will need permission from the school principal to participate.		
School Name		
Student Name		
Student Grade Level 2021-2022		
Parent/Guardian Name		
Home Address		
Parent Phone Number		
Parent Email Address		
Student Phone Number		
Student Email Address		

DECLARATION OF INTENT	
	
I would like to declare my intent to participate in the College Credit Plus program. I understand that signing this form does not require that I participate during the upcoming school year, and I may decide not to participate without consequence.
I also understand that it is my responsibility to notify my school if I do not gain admission to my selected institution of higher education or choose not to participate in the program.
In addition, I certify that I have received counseling about the College Credit Plus program concerning the rules and regulations for both my school and the college, and that I understand my responsibilities, the benefits and possible risks of participating in the College Credit Plus program.
Please sign and return this form to the secondary school by April 1. If you unable to sign this form digitally, please print it and sign the paper copy. Please check with your school counselor to see if you need to submit this form to them electronically or as a printed document.

Parent Signature   	

Student Signature   	

Date  	
Continued on page 2	

OPTION ELECTION FOR 2021-2022

For the 2021-2022 school year, select the payment option for the student’s course(s).
OPTION A: The student/family will be financially responsible for all tuition and the cost of all textbooks, materials, and fees associated with the College Credit Plus course.
O	The student must inform the secondary school whether the student wants to receive college credit only or high school and college credit.
OPTION B: The state of Ohio is financially responsible for the eligible course(s) in which the student chooses to enroll.
O	If Option B is selected, the funding for the course will be deducted from the secondary school and redirected to the college.
O	The student will receive high school and college credit.
COMBINATION OF OPTIONS A & B: Student/family chooses to be responsible for all tuition, textbooks, materials, and fees for one or more courses. If this option is chosen, the student must inform the college which course(s) will be under Option A and which will be under option B.
Please consult with your school counselor for more information and to choose the option(s) that best suits your College Credit Plus endeavors. Your selection of Option A or Option B is tentative on this form. You must confirm your selection by your college’s no-fault withdrawal date. You must also inform your high school of your final selection.