Concurrent Enrollment Fall 2019/Spring 2020
Enrollment Request Form
We are delighted that you will be taking advantage of the concurrent enrollment option offered through your
high school. This program allows you to take Colorado State University (CSU) classes for college credit while
you are still enrolled in high school. What a great way to get a jump-start on your higher education!
The concurrent enrollment option is a great opportunity to help you learn the process for attending CSU. As
such, you are required to submit information to Colorado State University and register for classes in the same
way regularly admitted students do. There are five steps in this process; those marked with an asterisk must be
completed each semester you intend to enroll in CSU courses through concurrent enrollment:
Step 1: Complete the Enrollment Request Form (this packet)*
Step 2: Create your eID (electronic Identity)
Step 3: Complete Registration Ready*
Step 4: Apply for and authorize COF (Colorado Opportunity Fund)
Step 5: Register for classes*
This enrollment request form serves as a request to register for classes through the Concurrent Enrollment
program established with your high school. The form contains several sections, some of which need to be
completed by the student and parent, others need to be completed by an official in the school district. Be sure
all sections are complete and contain the appropriate signature(s).
Once your enrollment request form is received and processed by the Office of Admissions at Colorado State
University, we will contact you via email so that you can continue with steps 2-5 for registration.
Please type or print legibly in ink. Be sure to answer ALL questions and sign this form.
DEADLINES:
The Enrollment Request Form (Step 1) should be submitted to the high school administrator at your school by
August 13, 2019, and no later than August 16, 2019, so that they may be submitted to the CSU Office of
Admissions on time. Classes begin for the fall 2019 semester at Colorado State University on August 26, 2019.
Forms received by Colorado State University after September 11, 2019, will not be processed.
The remaining steps (2 – 5) must be completed no later than September 11, 2019. Requests for late
registrations in the Concurrent Enrollment program will NOT be processed.
Office of Admissions
1062 Campus Delivery
Fort Collins, CO 80523-1062
(970) 491-6909
FAX: (970) 491-7799
admissions.colostate.edu
This form is to be used by high school
students in the Poudre School District who
have been approved to take CSU courses
at the CSU Fort Collins campus.
CONCURRENT ENROLLMENT FALL 2019/SPRING 2020
ENROLLMENT REQUEST FORM- Page 2
STUDENT INFORMATION
Full Legal Name
Last First Middle Maiden or Former Name
Social Security Number Gender Date of Birth Age
Used to verify your eligibility for COF (Colorado Opportunity Fund); collected pursuant to the institution’s authority under §24-72.3-102(2), C.R.S., to request a person’s SSN when it determines that receiving the SSN is
essential to the provision of services)
Mailing Address:
Number and Street or Post Office Box City County State Zip Code
Telephone Numbers: Home: ( ) Cell Phone: ( )
Area Code Number Area Code Number
Student email: ________________________________________ Parent Phone: ( )
Area Code Number
Parent email: _________________________________________
Ethnicity (Select one)
Hispanic/Latino (incl Chicano, Cuban, Puerto Rican,
Mexican American)
Not Hispanic/Latino
Race (select one of more as applicable)
American Indian or Alaska Native (Original Peoples)
Asian, Japanese, Chinese, Vietnamese, Korean, Filipino
(including Indian subcontinent)
Black, African American (including Africa and
Caribbean)
Native Hawaiian or Other Pacific Islander (Original
Peoples)
Citizenship (select one):
U.S. Citizen
U.S. Permanent Resident
Resident Alien No. A- _________
Date issued: _______
Parent Resident Alien No. A- ___________
Date issued: __________
Non- U.S. Citizen or Permanent Resident*
*International students attending high school on an F1 Visa are not eligible
for the concurrent enrollment program.
White, Anglo, Caucasian (including Middle East, Persia)
HIGH SCHOOL INFORMATION
Year in School Freshman Sophomore Junior Senior
High School Name: ____________________________ Planned High School Graduation Date: ______________
What course(s) will you be taking through the Concurrent Enrollment program?
Course # 1 _____________________________
Course # 2 _____________________________
Course # 3 _____________________________
CRITICAL INFORMATION
You must answer the following questions or your application will be delayed.
All Colorado colleges/universities are required to ask the following questions to support a safe campus community. “Yes”
responses are given careful consideration to include the scope and severity of the situation, how it was resolved and what has
happened since the occurrence.
Do you have any criminal charges pending against you or have you ever been convicted of a crime, made a plea of guilty,
accepted a deferred judgment, been adjudicated or been required to register as a sex offender? (Moving violations, such as
speeding tickets, are exempt, but DUI/DWAI must be included.) If yes, attach an explanation. Yes No
Have you ever been found responsible for any disciplinary violation at an educational institution you have attended from the 9th
grade forward (or the international equivalent), whether related to academic misconduct or behavioral misconduct, that resulted in
your probation, suspension, removal, dismissal, or expulsion from the institution? If yes, attach an explanation. Yes No
To comply with Colorado state law, all males between the ages of 17 years 9 months and 26 years must answer the following
question: Are you registered with the selective service? Not applicable Yes No
CONCURRENT ENROLLMENT FALL 2019/SPRING 2020
ENROLLMENT REQUEST FORM- Page 3
IMPORTANT NOTES:
Attention student: Prior to adding, dropping or withdrawing from a class, you must see your school
counselor, or other school official designated as the concurrent enrollment officer.
Attention student and parent/guardian: Your signature indicates that you wish the above named student to
participate in the Concurrent Enrollment program and agree to the following:
• Advice and counsel regarding such participation has been received from the student’s current high
school.
• The course(s) fits with the student’s Individual Career & Academic Plan (ICAP).
• The student and/or parent will be responsible for payment for any tuition and fee assessment
and any other charges incurred by the student that are not covered by the agreement between
the school district and Colorado State University.
High School students in the Concurrent Enrollment program are billed base tuition at the Undergraduate and Colorado
Resident rate. Please visit https://financialaid.colostate.edu/base-tuition/
and select “Undergraduate and Colorado
Resident” for specific amounts. Students in this program are not billed General Fees, the University Technology Fee or
University Facility Fees unless the student wants to utilize University services and agrees to pay the required fees for
part-time students. For the 2019-2020 academic year, Poudre School District will cover no less than $148.90 per credit
hour of the student’s bill. The exact cost covered by PSD will be updated once FRCC’s tuition is released. For additional
information regarding the portion of the bill covered by Poudre School District, please contact Poudre School District.
• Your signature below authorizes your high school/school district to release your SASID number to
the college for the purpose of COF.
Student Permission to Release Academic Records
Under the terms of the Family Educational Rights and Privacy Act (FERPA), a student’s educational record
is, with certain exceptions, held confidential by Colorado State University. A student may grant permission
for information to be provided to a third party by completing this consent form. Students enrolled through
Concurrent Enrollment must sign this form in order for parents to receive information about the student.
This release pertains ONLY to academically related education records, and may not be used for the purpose
of releasing records related to employment, medical records, financial aid, student billing, tuition
classification, disciplinary actions, or law enforcement. Any such requests must be directed to Student
Employment Services, CSU Health Network, Student Financial Services, Conflict Resolution and Student
Conduct Services, or Colorado State University Police as appropriate.
• In compliance with the Family Educational Rights and Privacy Act (FERPA) of 1974, the student gives permission to
Colorado State University to report absences, disciplinary issues, and the release of grades, transcripts, in progress
grades, and class schedules, as available, to the above noted High School for the courses enrolled under the Concurrent
Enrollment program.
• In compliance with the Family Educational Rights and Privacy Act (FERPA) of 1974, the student gives permission to
Colorado State University to release any available academic records that the university maintains (e.g., grades, academic
standing, academic advising, etc.) to the parent(s) or guardian(s) listed below. The student can revoke or amend this
authorization at any time by written request and signature.
_______________________________ _______________________________
Parent or guardian name (please print)
Parent or guardian name (please print)
_______________________________ _______________________________
Parent or guardian name (please print)
Parent or guardian name (please print)
CONCURRENT ENROLLMENT FALL 2019/SPRING 2020
ENROLLMENT REQUEST FORM- Page 4
Student Name: _______________________________ SASID: ______________________
SIGNATURES
I hereby certify that to the best of my knowledge the information furnished on this form is true and complete. I understand
that if found to be otherwise, it is sufficient cause for rejection or dismissal. The signatures below certify that:
• I have read all material contained in this packet, and understand my rights and responsibilities with regard to
registration, tuition, fees, and the release of grades to the high school or school district.
• I will meet the same course expectations and prerequisites as college students, as noted in course catalog and/or
syllabus.
• The course satisfies college degree, certificate, and/or remedial education requirements and is in line with the
student’s ICAP.
• Course credits may transfer if I earn a C or better in a Guarantee transfer course, or accepted by post-secondary
institution.
• The grade received in this course will appear on my official high school and Colorado State University college
transcript.
• If I withdraw from a Concurrent Enrollment course after the drop/add date, I will receive a W or F on my college
transcript. My parents/guardian will be responsible to repay PSD any tuition for W or F.
• With regard to college activities, qualified students may participate in activities but are not eligible for NCAA
athletic activities.
• I will need to apply for the College Opportunity Fund and I understand the credits earned will be deducted from
the COF lifetime account, at institutions which receive COF funding.
Applicant’s Signature _______________________________________________________Date ____________________
Parent/Guardian Signature ___________________________________________________Date ____________________
Under the Colorado Open Records Law, Colorado State University may be required to make public, upon request, information contained in this
application.
STUDENT ELIGIBILTY
I certify that the above named student is eligible to take courses through Concurrent Enrollment and meets any
stated pre-requisites for the class(es).
Principal (or designee) name: _____________________________________
High School: __________________________________________________
Signature: _______________________________________ Date: _________________
Comments:
The school district agrees to pay a number equivalent to FRCC’s cost per credit per CSU credit for ______
credit(s) this term:
Printed name: ____________________________________ Title: ________________________
Signature: ___________________________________ Date: ______________
CONCURRENT ENROLLMENT FALL 2019/SPRING 2020
