dual enrollment program agreement (Form 508)

IRSC Student ID Number

Dual Enrollment Program Agreement

Note: Asterisks (*) indicate required fields for this form to be considered complete.

Student Information

  • First Name: Text field (Print legal name in full) – Required
  • Middle Name: Text field
  • Last Name: Text field – Required
  • Suffix: Text field (Jr, II)
  • Mailing Address: Text field (Street Address or PO Box) – Required
  • City: Text field – Required
  • State: Text field – Required
  • Zip Code: Text field – Required
  • County: Text field
  • Home Phone Number: Text field
  • Student Cell Phone Number: Text field – Required
  • Date of Birth: Text field (MM/DD/YYYY format) – Required
  • Name of Current High School: Text field – Required
  • High School City: Text field – Required
  • High School County: Text field – Required
  • Anticipated Graduation Month: Text field – Required
  • Anticipated Graduation Year: Text field – Required
  • IRSC Student ID Number: Multiple boxes for numeric entry

Eligibility Requirements

Students must meet all of the following eligibility requirements to participate in the Dual Enrollment program:

  • Students must have a minimum unweighted GPA of 3.0 to enroll in any college credit course and 2.0 for vocational clock hour courses. Students enrolled in a Special Program may participate with alternate standards. (See Special Programs in the dual enrollment articulation agreement with your school or school district)
  • Students must demonstrate college readiness by achieving or exceeding minimum scores on Common Placement Tests, Alternative Placement Tests, or by approved High School Coursework as provided under SBE Rule 6A-10.0315.
  • Student must complete this Program Agreement (Form 508), signed by the student, parent/guardian and/or high school counselor
  • Home School students must provide proof of enrollment in a Home education from student’s local school district.
  • Personalized Education Program students must provide proof of enrollment in a PEP program from Step Up.
  • Student must meet any other eligibility requirements listed in their high schools articulation agreement with the College.

Student and Parent Agreement

We, the student and parent or legal guardian, agree for the above named to enroll in the Dual Enrollment program offered in coordination with the school district and Indian River State College. We understand the course selection for enrollment will be authorized each term by the high school counselor for courses that are creditable toward the high school diploma. We understand that any course that ends after the date of the student’s high school graduation is not eligible for Dual Enrollment. We agree to abide by the guidelines of the Dual Enrollment program, as well as the College policies and procedures, while enrolled in IRSC. We will cooperate with both the high school and the College in fulfilling responsibilities. We understand that any courses registered for, or grades received, become a permanent part of the student’s college record. At the end of each semester, we authorize IRSC to forward grades to the high school. Because these credits apply towards high school graduation, we understand it is the student’s responsibility to receive approval from the high school counselor for permission to drop or withdraw from a Dual Enrollment course.

Student Accessibility Services

IRSC asks for voluntary self-identification of students with a documented disability. High School accommodations do not automatically transfer into college. Student must apply and submit documentation for accommodations for Dual Enrollment courses. Speak to your Advisor for application and more information.

Acknowledgment and Authorization

By signing below, the student applying to enter a Dual Enrollment program, has read, understood, and consents to the agreement above. I authorize IRSC to discuss my college record with my high school counselor and the parent or legal guardian listed below. We certify that all the information submitted in the agreement is true to the best of our knowledge. We understand that any misrepresentation of facts may result in the immediate cancellation of the student agreement or registration. Students who change school locations must notify the College immediately and submit a new form.

Signature Section

  • Student’s Signature: Signature field – Required
    • Print Name: Text field
    • Date: Date field

  • Parent’s or Legal Guardian’s Signature: Signature field – Required

    • Print Name: Text field
    • Date: Date field

  • Additional Parent’s or Legal Guardian’s Signature: Signature field (Optional)

    • Print Name: Text field
    • Date: Date field

Asterisks (*) are required fields for this form to be considered complete.