Boulder Valley School District



File: IGCD-E1 (pdf)
Adopted:  March 1998; March 12, 2013

Boulder Valley School District
6500 East Arapahoe Road
Boulder, CO 80303


Student Name____________________________________________________________
Address_____________________________________________ City________________
State_______ Zip_______
Telephone_________________________ Soc. Security#__________________________
High School________________________ Grade___________ Date of Birth___________
Choice of Institution______________________
# of High School Credits Earned to Date_______
Requested Course Title #1__________________________________________________
Course Reference Number (s) __________________ Number of Credit Hours_________
Requested Course Title #2 __________________________________________________
Course Reference Number (s) __________________ Number of Credit Hours_________
TERM _____ (year)
    Credit                                                 Semester                 Quarter
    ____ High School                              ____ Fall         ____ 1st ____2nd
    ____High School & College              ____ Spring     ____3rd ____4th

I authorize the postsecondary institution to release the above student's grades to the high school of enrollment and to the District Office of Boulder Valley School District. I understand I am responsible for paying tuition costs for courses for up to two classes per semester to be reimbursed by the school district upon proof of successful completion of those courses. I understand that the Postsecondary Options Program is a concurrent program meaning that the student must be enrolled in a minimum of two classes at a district high school while attending an institution of higher learning, and that it is the intention of the student to graduate from high school. This form must be submitted to the counseling office at least 60 days prior to enrollment at the requested college/university. There will be no exceptions to this deadline (see counseling office for specific semester deadline dates).

Student Signature______________________________ Date__________________
Parent Signature________________________________ Date__________________


For High School Office Use Only

Date of parent/student-counselor conference ___________________
Principal/Counselor signature________________________________
    ______ Approved     __________ Denied


End of File: IGCD-E1