2016-17 Dual Credit Parent/Student Release and Guarantee of Payment

  • Student Acknowledgement (Check each box)

  • Parent/Guardian Acknowledgement (Check each box)

  • As Parent or Legal Guardian of the student above, I agree that I am responsible for the payment of any tuition, textbooks, parking permits, and fees associated with him/her participation in the Kentucky State University Dual Enrollment Program. Furthermore, full payment of tuition will still be required if him/her fails to withdraw from a course prior the last day to add/change registration (see below). Fall 2016 August 20th: Classes begin August 26th: Last day to add/change registration for a refund (form due)
  • All forms must be completed and returned each semester no later than one week after classes begin. Failure to return the form in a timely manner will result in a student being withdrawn from their courses.

All high school (not home-school) students participating in Kentucky State University’s Dual Credit program must have their parent or guardian submit the Dual Credit Parent Authorization of Payment Form. This form is due no later than 4 pm on August 12, 2016.