Welcome to the Dual Enrollment Program!

We are so happy that you are interested in taking courses at our college.

Use this form to select the classes you are interested in taking. Once submitted, this form will be sent to your high school for approval and if approved will be sent to Chaffey's Admissions and Records Department. They will update your account within 3 business days which will allow you to register.

If you have questions or need support getting started, please contact our department at dual.enrollment@chaffey.edu.

OUR TEAM LOOKS FORWARD TO SUPPORTING YOUR GOALS AT CHAFFEY COLLEGE!

SPRING 2022 NON-HIGH SCHOOL PARTNERSHIP (NON-HSP) DUAL ENROLLMENT E-AGREEMENT

This form is only for students who have completed Chaffey College's application and received their 7-digit Chaffey College ID#. 

  • If you need to apply to Chaffey College learn how to do so from a quick and easy how-to video available HERE. You will receive your Chaffey College ID# in 48-72 business hours after completing the application via e-mail. 
  • Please note that sections with a red asterisk (*) must be completed to submit the form.

This form is NOT the High School Partnership (HSP) form for no-cost courses offered through high schools in the following districts: FUSD, CJUHSD, CVUSD, and UUSD. You may have to pay for some fees (usually between $15-20/semester) and/or textbooks if you self-register for classes approved through this form. For information on the HSP process, click HERE.

Your current high school

ATTENTION!!! 

YOU HAVE SELECTED A HIGH SCHOOL THAT OFFERS HIGH SCHOOL PARTNERSHIP (HSP) DUAL ENROLLMENT COURSES. THESE ARE COURSES WHERE THE BOOKS ARE PAID FOR AND YOU ARE NOT CHARGED ANY FEES. YOU WILL BE CHARGED FEES ($15-20) AND COST OF BOOKS TO ENROLL THROUGH THE FORM YOU ARE COMPLETING NOW. IF YOU ATTEND A HIGH SCHOOL IN ONE OF THE FOLLOWING SCHOOL DISTRICTS: CJUHSD, CVUSD, FUSD, OR UUSD, GO TO THE HIGH SCHOOL PARTNERSHIP SPRING 2022 AGREEMENT FORM TO SEE IF THE CLASS YOU WANT IS AVAILABLE ON THE DROP-DOWN LIST IN THAT FORM.

Please upload a current Private School Affidavit and a Transcript signed and dated by the Director or Principal Officer. Your Director or Principal Officer will also be required to digitally sign and type their name below.

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Director/Principal Officer: Please type your name below if you approve this student to enroll in the courses listed on this agreement form*
Date/Time of homeschool administrator electronic signature*
TYPE THE NAME OF YOUR HIGH SCHOOL PRINCIPAL OR COUNSELOR BELOW

STUDENT INFORMATION

Student's Name*
This is provided 72 hours after applying to Chaffey College. It is a 7 digit number starting with 0. Do not include initials or a CCC ID#.
Date of Birth*
Student's Address*
Do not use e-mails provided by schools
Current Grade Level*
Please select the grade that you will be in when taking the Chaffey course.
"Other" Grade Level
(Students may enroll as a 6th-8th grade student IF approved through the High School Student Appeal Petition - linked below)

Appeals

Students who do not meet the grade-level requirement may submit an appeal to the Appeals Committee with this appeal form.

  • Students must submit a dual enrollment e-agreement for the term requested in the appeal 
    • Continue with this form because it must be completed before the appeal
  • Submitting an appeal does not guarantee approval
  • A separate appeal is required for each semester/term of enrollment
  • The decision of the Appeal Committee is final

RECOMMENDED COURSES

Dual Enrollment Courses - These are Chaffey College courses taught at one of the three (3) Chaffey College Campuses or online.

Please review the following (if needed):

Please enter the course/s you would like to register for and the number of units associated with that course. Your High School Counselor/Designee will determine if you are eligible and should take the course/s. If there are any concerns or updates to your course/s they will inform you.

STUDENT AGREEMENT

Admission requirements for high school students are:

  • Be in the 9th-12th grade

I understand that I will be held to the following student responsibilities:

  1. I may not enroll in more than 11 units in any Fall/Spring semester, or 6 units in Summer term.
  2. I must pay for all applicable fees associated with my courses at the time I register, or I may be dropped from my course(s).
  3. I should complete the online Dual Enrollment Orientation.
  4. My High School Counselor/Designee will discuss any issues with the selected degree-applicable courses and/or my eligibility to take the courses. 

I understand that the classes I take will be a part of my official permanent college record and may impact my university/college admissibility.

Did you read and understand the responsibilities above?*
Use your mouse or finger to draw your signature above
Student's Signature Date*

COVID VACCINE MANDATE INFORMATION

If you choose to only take online classes and utilize student services online, you do not need to provide proof of COVID-19 vaccination. Please know, however, that you will not be able to utilize any on-campus services, including the campus bookstore, without submitting proof of vaccination. The bookstore offers free shipping or contactless pick-up.  All Chaffey students enrolling in and taking in-person or hybrid courses in the spring 2022 semester must submit valid documentation of “full” COVID-19 vaccination. This is a prerequisite that must be fulfilled by submitting your completed Center for Disease Control (CDC) Vaccination Record card through the MyChaffey Portal.

SPRING WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

PARENT/GUARDIAN CONSENT

I give my consent for my child to be enrolled at Chaffey College as a special part-time student. I understand that my son/daughter is being considered for admission as a college student and will abide by all college rules, regulations, and deadlines. I understand that costs for community college courses are the responsibility of the student. In compliance with the Family Education Rights and Privacy Act, I understand that Chaffey College may share my academic information with the k12 governing board designee associated with the high school noted in this form and that Chaffey College will not release any student records other than directory information to any other entity or individual, including the parent(s), without the written consent of the student. 

WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

Hereinafter called the “Activity,” I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue the Chaffey Community College District, its officers, employees, and agents from liability from any and all claims including the negligence of the Chaffey Community College District, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the High School Partnership/Dual Enrollment Program (the Activity). 

Assumption of Risks: Participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. 

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD CHAFFEY COMMUNITY COLLEGE DISTRICT HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in the Activity and to reimburse them for any such expenses incurred. 

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California including Education Code Section 72640 and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 

Acknowledgment of Understanding: I have read all previous paragraphs, including the waiver of liability, assumption of risk, and indemnity agreement, know, fully understand its terms, acknowledge these and other risks that are inherent to the Activity, and understand that I am giving up substantial rights, including my right to sue. I acknowledge my participation is voluntary, that I knowingly assume all such risks, and that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the extent allowed by law. 

In the event of any illness or injury, I give full authority to the district staff to obtain such medical treatment and/or surgery from a licensed physician/surgeon, paramedic or hospital as deemed necessary for the welfare of my child. I acknowledge that I fully and completely understand the potential risks that may be associated with this Activity and that my child’s participation is strictly voluntary. 

Additional Information - Supervision of Minors: Chaffey College assumes no responsibility for the supervision of minor students outside the classroom setting. Parents are responsible for providing transportation and ensuring their children are supervised before and after class, and if or when a class is cancelled or dismissed earlier than the scheduled time. Chaffey College will not call the parent/guardian if a student is absent, nor will we verify attendance. 

Course Content: College is an adult environment with minimal supervision. Discussion topics and course materials are generally designed for adult students and may not be appropriate for younger students. Course content will not be altered to accommodate younger students. 

Release of Academic Information: In compliance with the Family Education Rights and Privacy Act, I understand that Chaffey College may share my academic information with the k12 governing board designee associated with the high school noted in this form and that Chaffey College will not release any student records other than directory information to any other entity or individual, including the parent(s), without the written consent of the student. 

Internet Usage: Many courses required computer lab work or research projects that could involve the Internet. Chaffey’s computer network provides access to the Internet in classrooms, labs, and the library. The College does not block access to specific Internet sites. As a result, it is possible for your son/daughter to reach an Internet site that you may feel contains inappropriate material. 



Did you, the student, read and understand the Waiver of Liability, Assumption of Risk, and Indemnity Agreement Guidelines?*
Use your mouse or finger to draw your signature above
Did you, the parent/guardian, read and understand the Waiver of Liability, Assumption of Risk, and Indemnity Agreement Guidelines?*
Parent's/Guardian's Name*
Parent's/Guardian's Signature Date*

EMERGENCY INFORMATION

EMERGENCY CONTACT

In the event of accident or sudden illness, Chaffey College will attempt to contact the emergency contact at the phone number(s) listed below. Please list a designated contact.

Emergency Contact's Name*

HEALTH INSURANCE

Please include the student's health insurance information below.

TRANSPORTATION - OMNITRANS GO SMART

Chaffey College offers the Omnitrans Go Smart Program, which enables you to ride any of Omnitrans’ fixed route buses with your Chaffey College Student ID Card for a per-semester fee of $8 for a part-time student. If you interested in this participating in this program please complete the steps below:

  1. Register for a course
  2. E-mail admissions@chaffey.edu
  3. Pay $8 fee
  4. Complete the "Student ID Card Request" form located in MyChaffey Portal.

Template for admissions@chaffey.edu e-mail:

My name is John Smith. My student ID number is 0123456. My date of birth is 01/01/2004. I would like to participate in the Omnitrans Go Smart Program and agree to pay the $8 fee.

To learn more about the program please feel to visit Go Smart Frequently Asked Questions.

ELIGIBILITY VERIFICATION

High School Counselor/Authorized School Designee

Below are the minimum eligibility requirements for high school students:

  • Be in the 9th-12th grade
Is the student enrolled in the 9th-12th grade at your high school or a student at your middle school?*
Do you recommend the student be permitted to take the college level degree applicable courses indicated previously?*
I do not recommend the student be permitted due to:*
Do any of the recommended courses have a requirement (prerequisites/co-requisite) in-order to register for the course/s? To view college course pre-requisites in the catalog use this link: https://www.chaffey.edu/catalogandschedule/docs/catalogs/2020-2021-courses.pdf*
Were any of the recommended courses changed/updated by you the High School Counselor/Designee?*
By typing my full name below I affirm the accuracy of the information given in this agreement and provide my electronic designee signature verification.*
Authorized School Designee Declaration Date:*

Admissions & Records

Term *
Has the student successfully completed the form?*
Checkbox*
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