Crowley's Ridge College - The college that feels like home.
100 College Drive
Paragould, AR 72450
(870) 236-6901
(870) 236-7748 fax

Dual Enrollment Registration Form

    PART I – TO BE COMPLETED BY THE STUDENT



    Student Name * :
    High School * :
    Phone * :
    Email Address * :
    I am requesting to enroll in the following courses this semester:



    No. Semester
    Example: Spring 21
    Course Number
    Example: ENG-113
    Course Title
    Example: Freshman Composition I
    Credit Hours
    Example: 3
    1
    2
    3
    4
    5

    By signing this form, I acknowledge that I have read the Concurrent Enrollment Student Guide and agree to abide by the academic regulations included in it. I understand that as a high school student under the age of 18, my parent(s)/legal guardian(s) have the right to review my college records according to FERPA guidelines. I also understand that I must submit an online application in order for this form to be processed. Further, I have met all criteria to take the courses I have requested to enroll in.



    STUDENT SIGNATURE (REQUIRED) * :
    DATE * :



    PART II – PARENT/LEGAL GUARDIAN
    By signing this form, I agree to comply with all rules and regulations set forth by the Crowley’s Ridge College Concurrent Enrollment Student Guide. I understand that final grades for any college course will become part of my child’s permanent academic record. Further, I understand that official transcripts will not be released to my child until payment of all amounts owed to CRC have been submitted. I agree to make these payments promptly.