175 Sam Sibley Drive
Student Services Center
Natchitoches, LA 71497
O 318.357.4078
800.767.8115
F 318.357.4660
[email protected]
Northwestern State University/Northshore Technical Community College
Cross-Enrollment Agreement
Name: __________________________ _________________________ _________________
Last
First
Middle
Cross-Enrollment Semester: Fall/Spring/Summer
NSU CWID# _________________
Year: ______________
Have you ever attended, registered, and/or paid tuition/fees at NTCC? ______Yes
If so, when __________________
Course to be cross-enrolled in:
Cross-Enrollment Institution
Northshore Technical Community College
__X___ MATH 0099A
COURSE NAME: Algebra Fundamentals
______ No
Home Institution Equivalency
Northwestern State University
___X__ Math 0920/0922
Students who are conditionally admitted to Northwestern State University must complete the following:
 The 5-credit-hour math (MATH 0099A - Algebra Fundamentals) must be completed with a grade of
“C” or better and must be completed within the first three semesters of enrollment.
 Students must complete the subsequent college-level math or English course in the next term of
enrollment.
 Failure to complete the conditions above will result in a registration hold that will not be lifted
until the student transfers the required course or test score to NSU.
By signing this form, I understand I am entering into an agreement with Northshore Technical Community
College and Northwestern State University. The information submitted on this agreement is true to the
best of my knowledge. I understand that withholding or giving incorrect information may cause me to
become ineligible for admission and enrollment at Northshore Technical Community College and
Northwestern State University. I allow the release of my transcripts, grades and relevant student data to
both institutions throughout the term of this agreement.
Applicant’s Signature _______________________________________________
DN
Date __________________________