Parent Permission Revocation Form

Revocation of Parental Permission

Please fill out this form to revoke your consent for your child to take dual enrollment and CCAP courses through Columbia College
You agree to withdraw consent so that your child may no longer be considered a Dual enrollment student:

•       Student will be unable to enroll in college courses as a high school student.

•       Student will not longer receive access to services provided by Columbia College.

•       Student will be removed from any current college courses if within the first two weeks of the semester.

•       Student will be barred from future Columbia College courses while in High School, unless a new dual enrollment form with parental permission is submitted.

•       Signing this form does not stop the student from applying and starting at Columbia College after graduating high school.
Full name of the person you revoke authorization from

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Date Signed

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Revocation of Parental Permission