College Credit Plus Intent Form

Please complete all of the required fields below and submit. Upon submission, a copy of the form will be sent to the email addresses you list below and Mrs. Westbrook, School Counselor. The deadline to submit this form is April 1st.

Today's Date

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School Name(*)

Quaker Digital Academy

Quaker Preparatory Academy

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Student's First Name(*)

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Student's Last Name(*)

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Parent/Guardian Name:(*)

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Home Address(*)

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Parent/Guardian Phone:(*)

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Parent/Guardian Email:(*)

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Student Phone Number

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Student Email:

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I would like to declare my intent to participate in the College Credit Plus program. I understand that signing this form does not require that I participate during the upcoming school year, and I may decide not to participate without consequence.

I also understand that it is my responsibility to notify my school if I do not gain admission to my selected institution of higher education or choose not to participate in the program.

In addition, I certify that I have received counseling about the College Credit Plus program concerning the rules and regulations for both my school and the college, and that I understand my responsibilities, the benefits and possible risks of participating in the College Credit Plus program.

Please sign and return this form to the secondary school by April 1.

Parent/Guardian Signature(*)

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Student Signature(*)

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Quaker Academies

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School Information

Quaker Digital Academy (IRN 000241) and Quaker Preparator Academy (IRN 019156) are Ohio Public Schools with offices in New Philadelphia, Steubenville, and East Liverpool.

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