College Credit Plus (CCP) Authorization Page
North Central State College
Directions to Student:
1. After you have submitted your electronic College Credit Plus Application at www.ncstatecollege.edu/ccp
2. Complete the Student and Parent section of this form.
3. Take this form to your School Counselor for their signature and to obtain a copy of your transcript.
4. Return your completed CCP packet (Authorization Form, Transcript and all available Test Scores) to North Central State College:
Email: [email protected] Mail: NC State College, Kee Hall 2441 Kenwood Circle Mansfield, OH 44906 Fax: 419-755-4757
STUDENT & PARENT SECTION:
In which semester will you begin CCP courses? ____ Summer ____ Fall ____ Spring
School Year _______-_______
Student Name _____________________________________________________ Primary Phone ____________________
Last
First
MI
Birth Date ____ / ____ / ____ What school do you attend? _________________________________________________
If applicable, what Career/Tech Center do you attend? ___________________ Do you need athletic eligibility?
Y/
N
*If you attend a non-public or home school, you must also apply for CCP funding hours from the State of Ohio each year, and
ensure you are meeting the state mandated deadlines. For more information visit www.ohiohighered.org/ccp.
STUDENT AND PARENT please read carefully and sign:
Financial Responsibility: If the student fails to successfully complete one or more courses (a course withdraw or course fail), the
student/parent assumes full financial responsibility for the course and related expenses payable to the secondary school.
I understand that if my enrolled credit hours exceed the annual (30) or lifetime (120) maximum as defined by CCP, I am financially
responsible for tuition, fees, and books for those college courses exceeding the maximum. If I am a student in a non-public school, I
understand that, should the state choose not to fund my participation, I will be responsible for the payment of tuition, fees, books
and materials required for each course.
____________________________________________________________________________________________________________________________________
Signature of Student
Date
____________________________________________________________________________________________________________________________________
Signature of Parent/Legal Guardian
Print Name
Date
SCHOOL COUNSELOR SECTION:
Academic Planning: (Optional Notes Section for School Counselor)
Under CCP, students may take a maximum of 30 credit hours of combined high school and college credit per academic year.
The academic year starts with Summer Semester. Formula to annually determine a student’s number of CCP eligible college credits:
30 – (Carnegie units x 3) = Available College Credits under CCP
1. Pertinent Notes (Graduation requirements sought through CCP; Min/Max no. of CCP courses or credit hours; Career
interests; Intended courses etc.):_____________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
•
•
•
I have attached a copy of the student’s most recent transcript of grades and test scores if applicable.
I have met with this student, discussing the advantages/disadvantages of participating in the College Credit Plus Program.
(If known) The above student is registered for ______ Carnegie units at the secondary school, and is eligible to take ______
credits at NCSC this year. No more than the equivalent of 30 college credits for the year and 120 college credits in total can
be taken by any student in CCP.
Signature of School Counselor ________________________________________________________________________ Date _________________________________________