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1.888.INFO.MJI  Academic Departments  High School  Course Authorization A
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This form is to be completed and verified by the high school principal, guidance counselor or other relevant high school representative.  The form must be completed each time a class is requested from MJI. 

This form is only for students who will be taking classes under the Dual Enrollment Act.  For students not taking classes under the Dual Enrollment Act, please use the form titled Course Authorization B.



Student First Name   
Student Last Name  
Level of High School during MJI Attendance  
Name of High School Counselor   
Counselor Phone Number   
MJI Course Requested   
Semester Attending MJI  



Please select from the following options (Click all that apply)

I certify that the above named student meets the conditions outlined in the Post-secondary Enrollment Options Act.

I certify that this school district will reimburse MJI for a portion of the course indicated in the amount authorized as required by the State School Aid Act.


Please select from the following options (Click only one)

I certify that the student needs this class to graduate and will be receiving both high school and college credit for this class

I certify that the student does not need this class to graduate and is enrolling in the course in addition to his/her high school class schedule


 MJI Invoice should be submitted to the following:

Name of School  
Name of School District  
School Address   
Invoice to the Attention of  
Name of School Official  
In lieu of signature, last 4 digits of SSN of School Official  


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