Dual Credit Student Registration

Please be aware you must fill out a seperate registration for each semester.

1. First Name
2. Middle Initial
3. Last Name
4. Address
5. City
6. State
7. Zip Code
8. Birthdate (MM/DD/YYYY)
9. Phone Number
10. Grade Level
11. Student Email
12. SVCC ID Ex. @99887766
13. Term Summer 2021Fall 2021Spring 2021
14. High School/Counselor Rob WissingerAmy DrewAimee StollerSteve HodsonAmy EbertPaula DurbandTerri HellerDave BaisdenStacey BontzJennifer StreetsDebbi KellyAmy FleckJim TurffsShannon CremeensSamantha BazarekIda HolperJason SandsJamie LeechJeffrey GaleChristine HerronKaileen GaumerDarci FrancisPam MedemaKaty KrumbholzJohn KotmanAmanda ClarkTest - Geoff Bork
15. Parent/Guardian E-mail Address
16. My electronic signature indicates that I give my consent and authorize Sauk Valley Community College to release my education records to my high school and to my Parent/Guardian (Please fill in Parent/Guardian)
17. If applicable I give my high school permission to release my IEP of information about accommodations through 504 to the Special Needs Coordinator at Sauk Valley Community College in order to arrange appropriate accommodations (Electronic Signature)
18. Electronic Signature