R 40 Form San Jose – Fill Out and Use This PDF

San Jose/ Evergreen Community College District	R- 4 0
San Jose City College	Evergreen Valley College
Telephone (408) 288-3700	Telephone (408) 270-6441

Attendance Approval for Special Part - time High School Students*

To the Director of Admissions & Records:

The student below has been granted approval to attend _______ San Jose City College / _______ Evergreen Valley College for the

_____________________ term as a Special Part -time Student . This permission is for the term indicated ONLY and must be

renewed, along with a new application for admission, each desired term of enrollment .

Please Print

Social Security Number		-	-	Telephone
Name						Date of Birth
	Last		First	Middle Initial
Address
	Number & Street		City			Zip Code
High School Now Attending					Grade (circle one) 9 10 11 12

Only classes authorized on this form by the High School Counselor/ Principal w ill be valid for credit upon completion. Any and all other classes registered w ithout authorization from the High School Counselor/ Principal w ill be dropped.

APPROVED COURSES							MAXI MUM 11 UNI TS
				Principal I nitial
				Principal I nitial
				Principal I nitial
Signature of Parent or Guardian* *		Relationship to Student					Date
Signature of High School Principal* *						Date

I n approving this student for enrollment in the class(es) listed on this R-40, the principal confirms that the total number of his/ her high school students recommended to attend SJCC or EVC courses adheres to the regulations and does not exceed the five percent limit outlined in CA Educational Code 76000/ 76001. Principal's initials here_______

** Mandatory I nformation

PROCEDURES:

1.STUDENT must complete a new application for admissions and submit a current ATTENDANCE APPROVAL form each semester of enrollment .

2.STUDENT must meet w ith the high school counselor to determine which subject areas would be most beneficial.

3.STUDENT must see that the high school principal signs this ATTENDANCE APPROVAL form.

4.STUDENT must obtain the signature of his/ her parent or guardian on this ATTENDANCE APPROVAL form.

5.STUDENT must deliver the completed application for admissions and the signed ATTENDANCE APPROVAL form to the Office of Admissions & Records.

6.STUDENT must take the assessment test and see a college counselor for proper course placement . STUDENT must meet prerequisite and basic skill requirements for any class in which they intend to enroll.

7.STUDENT should hand carry a copy of the high school transcript to the college counseling appointment .

8.STUDENT wishing high school credit must consult their high school registrar before enrollment . We grant college credit only.

9.Most fees are waived for high school students, however, STUDENT should be prepared to pay for any material fees.

*District policy requires that High School students must attend at least a minimum day at their high school and be in the 9th, 10th, 11th, or 12th grade (exception: Summer Session) to be eligible for admission to San Jose City College/ Evergreen

Valley College under this program. Student may enroll in approved courses only, and not more than 11 units.

Enrollment fees are w aived for High School students. How ever, High School students must pay any material fees

associated w ith the courses in w hich the student has enrolled. Beginning Summer 2000, courses taken at San Jose City College or Evergreen Valley College are offered for college credit only. Upon completion of the term, the student must request a transcript to be sent to the high school of attendance. The High School w ill determine if the course may be used for High

School Credit .

Rev. 05/06

White Copy - College

Yellow Copy - Student

Pink Copy - High School