Early College Agreement & FERPA Authorization Form

Student Information

First Name:

Middle Name:

Last Name:

Birthdate:

Semester of Enrollment (For example Summer 2025, Fall 2025, Spring 2026, etc)

High School:

High School CEEB Code

Phone Number:

Student Responsibilities

By signing this acknowledgment, I agree that I understand the following:

I must abide by the rules and regulations of both my high school and Chattanooga State Community College.
Early College and Early Technical College courses have the same rigor and pace as traditional college courses, and course materials, lectures, etc., are geared toward mature and responsible students. I must take responsibility for my learning, for submitting all assignments on time, and for contacting my instructor when I need assistance.
I must ensure any course selected will fulfill my graduation requirements.
Early College and Early Technical College courses appear on my college transcript as well as my high school transcript. The grading scale for high school classes may differ from that of the college grading scale.
I will officially withdraw through the Early College office from any course in which I am enrolled but decide not to complete. Failure to withdraw within the appropriate time period can result in a grade of "F" for the course and may affect any future financial aid.
I am responsible for fulfilling all course requirements that require textbooks, online activity, and use of other academic resources.
Payment of tuition and fees is required before I can attend class.
My grades, attendance, and any other academic information will be provided to my high school as part of this agreement.
The initial registration may change as deemed necessary by the ChattState Early College Office in partnership with my high school.
In most cases, I must be at least college level according to either ACT scores or Accuplacer Placement Test scores, except for Early Technical College.
By signing this form, I (the student) do hereby authorize the release of personally identifiable student record information, pertaining to myself, to my high school officials, college personnel at schools I register at as a DE student for the purposes of consortium agreement, and my parents and/or legal guardians. This information may include, but is not limited to, academic, financial aid, and student account records that are otherwise confidential pursuant to the Family Educational Rights and Privacy Act (FERPA, 20 U.S.C. 1232g) and/or the Tennessee Public Records Act (T.C.A. § 10-7-504).
Chattanooga State’s Office of Disabilities Support Services will coordinate accommodations with my high school’s special education department for me if I am taking an Early College or Early Technical College course on a high school campus and have special educational needs. To determine eligibility for these services, please contact your high school counselor or Chattanooga State’s Disabilities Support Services.

11th and 12th grade (10th, 11th, and 12th for Early Technical College/TCAT-CS dual enrollment students) TN residents only: I certify that I have completed the TN DEG (Dual Enrollment Grant) application for the semester I intend to enroll (Grant application can be found at https://www.tn.gov/content/tn/collegepays/tsac-student-portal.html). I understand that if I do not complete the application, or if I do not qualify for enough grant funding to cover my costs in full, I am responsible for all fees. The DEG will NOT cover the cost of books or special fees, if any, for a class.

If you are a male who is 18 years old or will turn 18 before the start of the academic term, you must register for Selective Service at https://www.sss.gov/Registration/ Register-Now/Registration-Form before you can register for classes. Once you have registered, enter your registration # here:

Consortium Agreement Acknowledgement

1. A consortium agreement establishes a limited agreement between Tennessee Education Lottery Scholarship (TELS) eligible schools that enables an eligible high school student enrolled at both schools within the same term/trimester to have their DEG based upon all enrolled hours. It authorizes the Home school to receive the student’s DEG funds on behalf of the Host school.

2. If the student signs a consortium agreement with another college as their “Home School,” the DEG will be certified by that college.

3. I understand that if the student drops/withdraws from courses at either school during the term/trimester of a consortium agreement, the student, parent or guardian may be required to repay the financial aid disbursed.

4. A student must submit the official Host school transcript for consortium credit/clock hours upon the completion of the term/trimester. DEG eligibility for a subsequent term cannot be determined without required transcripts.

Sexual Harassment Notice

The College prohibits all forms of sex discrimination, including sexual harassment and sexual misconduct. This prohibition exists in all of the College’s education programs and activities, including those in which high school students participate in dual enrollment, middle college, and other education activities offered by the College.

Any high school student who experiences or witnesses sexual harassment, sexual misconduct, or other sex discrimination in connection with a dual enrollment, middle college, or other education program or activity offered by the College is encouraged to the College’s Title IX Coordinator, whose contact information may be found here: https://www.chattanoogastate.edu/title-ix

Student Authorization to Disclose Educational Records to Parent/Guardian (Optional)

In acknowledgement of the Family Educational Rights and Privacy Act of 1974 (FERPA), I give Chattanooga State Community College permission to discuss my grades, attendance, academic standing, disciplinary action, financial obligations, or any other aspect of my student life with my parents or legal guardians while I am a dual enrollment student.

Disclose Records to (parent/guardian first and last name)

Relationship to Student

Please enter a word or phrase that can be used as a verbal password. The verbal password must be provided to ChSCC staff before any of your personal information can be released to a designee.

Indicate below the records that you give permission to disclose to the assigned parent/guardian above

If you selected Other, please explain

Student Signature (first and last name)

Student Acknowledgement

By signing this form, I (the student) do hereby authorize the release of personally identifiable student record information, pertaining
to myself, to my high school officials, college personnel at schools I register at as a DE student for the purposes of consortium
agreement, and my parents and/or legal guardians. This information may include, but is not limited to, academic, financial aid, and
student account records that are otherwise confidential pursuant to the Family Educational Rights and Privacy Act (FERPA, 20 U.S.C.
1232g) and/or the Tennessee Open Records Act (TNORA, T.C.A. 10-7-504).

Type your full name to sign this form:

Parent/Guardian Name

Parent E-mail Address