Cooperative Agreement Application

Step 1 of 2: Submit

To apply for a cooperative agreement, please fill out this form, including transcripts and program acceptance letter, if required.

Complete this form if you wish to attend another Illinois community college for a program that Prairie State College does not offer.
Please allow up to two (2) weeks for processing your application.

6. State: 
10 Please upload a PDF verifying your residency at the address you listed above. The document must show your first & last name and address. We cannot accept documents showing only the name of another resident at your address. Acceptable documents include the following:
  • Valid driver's license or state ID
  • Utility bill
  • Property tax record
  • Lease agreement
  • Insurance card
  • Voter registration card
  • Posted mail addressed to you
Please remove any identifiable information (e.g. account numbers) other than your name & address.
11. Is this a renewal of an existing cooperative agreement? 

Renewal of Existing Cooperative Agreement
12 Please upload your most recent grade report or unofficial transcript showing your current GPA.

Status at PSC
13. What is your status at PSC? 

Program at the Receiving College
Cooperative agreements can only be issued for current or future terms. Past terms are not eligible. Approved agreements are valid for up to one year from the start term (they may be renewed annually if you remain eligible).
15. For what term are you requesting the cooperative agreement to begin? 
16. For what year are you requesting the cooperative agreement to begin? 
18. What type of credential does the program provide? 
Selective Admission Programs

Selective admission programs have prerequisites beyond a high school diploma or GED. Many Allied Health programs such as Nursing, Dental Hygiene, or Physical Therapist Assistant are selective admission programs. If you have an acceptance letter to the program (not the college), the program is a selective admission program.
21. Is the program a selective admission program? 
Students applying for a cooperative agreement for a selective admission program must show evidence that they have been accepted to the selective admission program before the cooperative agreement can be approved.

Additional Documentation

Date: Saturday, 21 December 2024 (EST)
Name:
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