New Policy: 4-4-07
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This form shall be completed only once and shall be kept on file by the school.

I have read and understand the Concurrent Enrollment policies as listed in Policy IKG. I fully understand the expectations, benefits, and the responsibilities that I as a student have in participating in this program. I also fully understand the rules, consequences, and penalties for violating the policies associated with this program and other school-related expectations and guidelines.

Student's Signature: _____________________________________ Date: ________

Parent/Guardian's Signature: ______________________________ Date: ________

Counselor's Signature: ___________________________________ Date: ________

Please sign and return this Disclosure Statement to the high school counselor.

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