This document is an approval form for high school students to enroll in college courses through Houston Community College. It requires the student's contact information, emergency contact, and signature agreeing to refund policies. The high school counselor must also sign approving the specific courses. The bottom section lists policies on attendance, conduct, and disability services. It provides contact information for the college and lists the acting chancellor and board of trustees.

1. Print
Clear Form
APPROVAL FORM
STUDENT NAME
HCC ID NUMBER
HOME TELEPHONE
MAILING ADDRESS
STUDENT’S EMAIL ADDRESS AND
CELL PHONE
NAME OF EMERGENCY CONTACT/RELATION/PHONE
I understand that refunds are authorized only if HCCS cancels the class. Prior to registration all students must sign below indicating they
understand and accept this policy.
Are you currently attending high school?
Yes; No; if not, please complete Course Title, Meeting Time, and Location. All others have
your high school counselor complete the bottom section.
Are you an athlete who will be applying to a Division I or II college or university?
Yes; No
.
DATE
STUDENT SIGNATURE
FAX APPROVAL TO 713.718.7708 OR EMAIL TO ahs@hccs.edu
HIGH SCHOOL OFFICIAL MUST COMPLETE THIS SECTION
SCHOOL OFFICIAL’S PRINTED NAME
TITLE
TELEPHONE
HIGH SCHOOL NAME AND ADDRESS
SCHOOL OFFICIAL’S E-MAIL ADDRESS & SIGNATURE
School OFFICIAL’S signature is required for approved courses
COURSE TITLE
EXAMPLES
English 3A
Algebra 1B
MEETING TIME
SSu 1-4
Mon/Wed
LOCATION
Pinemont
WLGayHall
PRICE PER
CLASS
$175
TOTAL
175
175
$175
$175
$175
$175
HOW MANY CLASSES FROM ABOVE ARE ART, BCIS, OR BIM CLASSES?
X $10 =
$0
TOTAL FOR THIS SEMESTER
$0
POLICIES ON ATTENDANCE, DISCIPLINE, AND STUDENT CONDUCT; & A STATEMENT ON DISABILITY SERVICES
Students are expected to attend all classes regularly. Class attendance is the responsibility of the student, and the student should
consult the instructor for make-up assignments after an absence has occurred. On the seventh (7th) hour of absence, the student
is automatically dropped from the course. Complete cooperation is essential. Failure to maintain good self-discipline will result
in dismissal from class with a failing grade. Prior to FIRST DAY of class contact AHS either by phone 713.718.7611 or email
ahs@hccs.edu to officially DROP a class.
Student Policies on Discipline and Student Conduct are contained in the Student Handbook located at this website
http://www.hccs.edu/hcc/System%20Home/Departments/Student_Handbook/student_policies.pdf.
Any student with a documented disability (e.g. physical, learning, psychiatric, vision, hearing, etc.) who needs to arrange
reasonable accommodations must contact the Disability Services Office at the respective college at the beginning of each semester.
Faculty is authorized to provide only the accommodations requested by the Disability Support Services Office. If you have any
questions, please contact the disability counselor at your college or Donna Price at 713.718.5165.
PLEASE CALL 713/718-7611 FOR COURSES NOT LISTED AND FOR REGISTRATION INFORMATION.
ACTING CHANCELLOR—Renee Smith Byas. BOARD OF TRUSTEES— Bruce A. Austin, Sandie Mullins, Eva Loredo, Yolanda Navarro Flores,
Herlinda Garcia, Carroll G. Robinson, Leila Feldman, Neeta Sane, Christopher W. Oliver
Houston Community College System seeks to provide equal educational opportunities without regard to race, color, religion, national origin, sex, age,
or disability. Please visit the Houston Community College web site, www.hccs.edu, for the latest schedule and information regarding courses offered
at other HCC-Adult High School campuses. HCC makes no guarantees as to the accuracy or quality of information contained in this publication,
including but not limited to, the availability of courses. All information contained herein is subject to change without notice.
6133pg2:4/17/13