Dual Enrollment Articulation Agreement Request Form

Name of School*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Type*

Private School Charter School

Is your school part of a larger network of schools (i.e. Bridgeprep Academy, Doral Academy Preparatory School, Mater Academy)*

Yes No

Please indicate the schools that will be serviced under the context of this articulation agreement*

MDC Home/Feeder Campus*

Hialeah Homestead Kendall Medical MEEC North Padron West Wolfson

Please indicate the term in which you plan on offering dual enrollment opportunities for your students*

Fall 2023 Spring 2024 Summer 2024

Insurance Requirements

Please note that section 18 of the agreement requires the school to maintain the following insurance throughout the term of the agreement:

1. Commercial General Liability Insurance, including Contractual Liability, naming the “District Board of Trustees of Miami Dade College” as an Additional Insured, with minimum limits of liability of $1,000,000 per occurrence and in the aggregate.

2. School Leader’s Professional Liability Insurance, or its equivalent, with minimum limits of liability of $1,000,000 per occurrence and in the aggregate.

3. Workers’ Compensation, in compliance with Chapter 440, Florida Statutes, as may be amended, and Employer’s Liability, with minimum limits of $500,000 for accident or disease.

An original Certificate of Insurance evidencing the insurance required by the agreement and a copy of the General Liability Additional Insured endorsement must be submitted to MDC as required in section 18 of the agreement. Please submit your school’s insurance documentation here so that I can include with your signed agreement.

Insurance Requirements*

No File Chosen

File uploads may not work on some mobile devices.

Principal's Name*

First Name

Last Name

Principal's Email*

Name of School Official that will serve as the primary contact for Dual Enrollment Agreement (i.e. Assistant Principal, School Counselor, etc).*

First Name

Last Name

Title of School Official that will serve as the primary contact for dual enrollment.*

School Official's Email*

School Official's Phone Number*

All dual enrollment agreements require a school official/signatory to attest on behalf of the school. Will the school official listed above serve as the designee to attest on behalf of the school? *

Yes No

This person must be someone other than the principal.

Name of the designee responsible for attesting on behalf of the school.*

First Name

Last Name

E-mail address of the responsible designee*

For the purposes of initiating the digital platform, the designee's e-mail address should not be a generic school e-mail address. . E-mail address should be associated with a school official.