UNIVERSITY OF WISCONSIN SYSTEM

EARLY COLLEGE CREDIT PROGRAM AND HIGH SCHOOL SPECIAL AGREEMENT FORM

Complete this form if you are currently enrolled in high school and wish to enroll for undergraduate courses at a University of Wisconsin (UW) System

institution before high school graduation. Please carefully read the instructions on page two before completing any part of this form. A separate form

must be completed for each UW System institution and for each term you wish to enroll.

SECTION I – STUDENT INFORMATION (TO BE COMPLETED BY STUDENT) (PLEASE TYPE OR PRINT IN INK)

Applying to: University of Wisconsin-_____________________________________ (use a separate form for each institution)

Applying for:  Fall Semester 20___________  Spring Semester 20___________  Summer Session 20___________

Applying as (check all that apply):  Early College Credit (school determines tuition payment)  High School Special (student pays tuition)

institutions. I authorize the UW System to provide information about my course registration, grades and attendance to my high school, school district

administrator and school board.

_____________________________________________________________________ _____________________________________________________________________

Student Applicant Signature & Date Parent/Guardian/Foster Parent Signature & Date

_____________________________________________________________________

Parent/Guardian/Foster Parent Printed Name

SECTION II – COURSE INFORMATION TO BE COMPLETED BY STUDENT (WITH HELP FROM COUNSELOR)

SECTION III – TO BE COMPLETED BY THE SCHOOL DISTRICT APPROVAL AUTHORITY/HIGH SCHOOL COUNSELOR/PRINCIPAL

This student has the permission of the high school administration to enroll in the above listed courses at the indicated UW System institution.

School District Approval Authority & Date High School Counselor/Staff Advisor Signature & Date

_______________________________________________ _______________________________________________ _______________________________________________

UNIVERSITY OF WISCONSIN SYSTEM

EARLY COLLEGE CREDIT PROGRAM AND HIGH SCHOOL SPECIAL AGREEMENT FORM

properly.

STUDENT/PARENT/GUARDIAN/FOSTER PARENT

The student has responsibility for:

 submitting this form, completed with all required signatures, to the district by the designated due date

 obtaining the admissions and registration information for the UW System institution he or she wants to attend

 completing the college admissions and registration processes, and

 informing his or her district of the courses in which he or she actually enrolls.

STUDENT SPECIFIC RESPONSIBILITIES

and October 1 for spring courses) to the School District in which student is enrolled. This is typically done by submitting the form to a

school counselor or Early College Credit Program Coordinator.

institution at which the Early College Credit Program course(s) was/were approved and work with the UW System institution

personnel as well as a high school counselor to enroll in appropriate course(s).

SCHOOL DISTRICT RESPONSIBILITIES

supporting documents to verify student eligibility.

the student and the district should receive/maintain a copy of the completed and signed application.

university.

UNIVERSITY OF WISCONSIN SYSTEM

EARLY COLLEGE CREDIT PROGRAM AND HIGH SCHOOL SPECIAL AGREEMENT FORM