EMC & DE: Tuition Authorization Form

Congratulations on enrolling in our Northwood University dual enrollment/early middle college program. This letter outlines the student’s and district’s responsibilities for this program. The table below outlines the course(s) the district has agreed to pay for per Section 388.514 of the Postsecondary Enrollment Options Act.

Eligible charges that can be paid are as follows: tuition, mandatory course fees, material fees, registration fees, textbooks, and late fees charged by the postsecondary institution for late district payment. Textbooks paid for by the district are considered the district’s property and are listed below.

Are you completing this form for a Dual Enrollment or Early Middle College Student?

Student's First Name

Student's Preferred Name

Student's Middle Name

Student's Last Name

Birthdate

Student's Email Address

Mobile Number

Home or Alternate Phone Number

High School

High School CEEB (hidden)

HS Level of Study (hidden)

Counselor's/Designated School Official's Email Address

Parent's Email Address

You are participating in dual enrollment at Northwood University in the following courses:

* Please note that none will be listed on your transcripts if you opt out of high school credit.

How many high school classes per term does a typical full-time student Enroll in?

How many high school courses is the duel enrollment course being counted as? (Most commonly 1 or 2)

College Course Name

# of Credits

High School Credit Issued For:

# of Credits

District Tuition Responsibility:

Other District-eligible Charges

Please upload your unofficial transcript. If you are not able to upload it, please have your school email it to admissions@northwood.edu.

By submitting this form, you agree:
• that you are responsible for paying the remainder of the costs associated with the class(es) listed above that exceed the minimum amount the school district must pay.
• that you are responsible for any late fees, transportation, parking cost, and any other costs incurred that are not outlined in this letter.
• to reimburse the district’s cost if you are unsuccessful in the courses listed.
• to release attendance and transcript records to the district as required.

This form acts as the district’s verification of your eligibility for dual enrollment.