Form Ys 1 – Fill Out and Use This PDF

LOS ANGELES COMMUNITY COLLEGE DISTRICT SUPPLEMENTAL APPLICATION FOR ADMISSION OF STUDENTS IN GRADES K-12

ADMISSIONU:UColleges in the Los Angeles Community College District (“LACCD”) may admit as a special part-time or full-time student anyone who is a student in grades K- 12 who has met the LACCD’s admissions requirements and who, in the opinion of the College President (or designee), may benefit from instruction. (Education Code sections 48800, 48800.5, 76001; LACCD Board Rules 8100.06, 8100.07, 8100.08; LACCD Administrative Regulation E-87.)

FEES:UUEnrollment fees are required for special full-time students (i.e., taking more than 11 units), but waived for special part-time students (i.e., taking 11 units or less). (Education Code section 76300(f), LACCD Board Rule 8100.03.) Effective starting Summer 2009, the nonresident tuition fee will be charged for all students who are classified as nonresidents; students may apply for an individual waiver pursuant to Board Rule 8100.15. The LACCD also charges a health fee (certain categories of students are exempt) and, where applicable, a student representation fee.

CONDITIONS:UU The student is expected to follow regulations and procedures that apply to all college students. The student shall receive college credit for the community college courses that the student completes. Arrangements for receiving high school credit for completed course work must be made with the student’s high school. The student may only enroll in those courses listed on this form. This enrollment approval form must be presented when the student initially files an application for admission to the college, and a separate approval must be provided for each semester or term in which the student wishes to enroll. The LACCD and its colleges assume no responsibility for the supervision of minor students (i.e., students under 18 years of age) outside the classroom setting. Parents are responsible for ensuring that their children are appropriately supervised before class begins, after class finishes, or when a class is cancelled and/or dismissed early.

KU-12 STUDENT INFORMATION

Student Name:

Birth Date:

/

/

Last

First

MI

Mo

Day Year

Student Address:

Street

City

State

ZIP

Phone No.:

(

)

E-mail Address:

Student ID No.:

FOR STUDENT: I authorize the release of my transcript information to my school upon the school’s written request.

Signature of Student

Date

FOR PARENT/GUARDIAN: I authorize my son/daughter to enroll in a college level course in the LACCD. I understand that my child will not be afforded any special status or supervision as a result of his/her minor status while enrolled in the Los Angeles Community College District; I also understand that I will not have access to my child’s student records (including grades and transcripts) without his/her written consent, his/her minor status notwithstanding.

Print Name of Parent/GuardianSignature of Parent/GuardianDate

COLLEGEU

ENROLLMENT INFORMATIONU

(to be completed by the K-12 school official)

Term:

Fall Semester

Winter Intersession

Spring Semester

Summer Session

Year:

College:

Enrollment Status:

Part-time (11 units or less)

Full-time (more than 11 units)

1.

2.

3.

College Course Subject/Number

College Course Subject/Number

College Course Subject/Number

4.

5.

6.

College Course Subject/Number

College Course Subject/Number

College Course Subject/Number

I have met and counseled the student and recommend the courses listed above to be taken for credit (for K-8 students, please enclose the student’s transcripts and letter describing how, in your opinion, the student will be able to profit from instruction at a community college). If this is a summer enrollment, I certify that there are no equivalent courses available at this school and that the total number of students referred from this school to community colleges does not exceed 5% of this year’s graduating class.

Print Name of Official		Signature of Official (original required)			Date
FOR LAUSD STUDENTS:
	LAUSD Student ID No.				School Location Code

		COLLEGEU	APPROVAL
	(to be completed by the College’s Chief Instructional Officer (or designee)
Approved to Attend	Not Approved to Attend
		Signature				Date
Reason(s) for Refusal:
Form YS-1						Effective 9/22/08

Instructions

LACCD Board Rule 8100.15 states that “students who are citizens and residents of a foreign country, or who are legally precluded from establishing residency in California, shall be entitled to exemption from nonresident fees on the basis of individual financial need in accordance with regulations adopted by the Chancellor. Such individual exemptions shall not be granted in excess of ten percent (10%) of the District’s students who are both citizens and residents of a foreign country in the applicable term. If you meet the eligibility requirements in question #9 on the Nonresident Tuition Fee Waiver Affidavit on the opposite side of this page, you may be eligible to receive a nonresident tuition exemption.

This form will be used to determine if you meet the exemption requirements established by this policy. If these guidelines apply, to you please fill out this form and return it to the Admissions and Records Office at your college.

Rev: 2/03/11 MDG