Cooperative Agreement Worksheet

Step 1 of 2: Submit

To apply for a cooperative agreement, please fill out this form, including transcripts and program acceptance letter if required. This is the first step in the application process. The process may take up to two weeks depending upon what you submit. If you are eligible for a cooperative agreement based on the information you provide, you will then be asked to fill out the official cooperative agreement form and provide documentation verifying your identity and in-district address.

Please fill out all information completely to avoid a delay in processing. If you have any questions while completing the form, please email Annette Dolph at adolph@prairiestate.edu or Rosalva Mendoza at rmendoza@prairiestate.edu.

Student Information and Academic HIstory

Name: City: State: Email address: Student Status: If you marked current or former student at PSC, please provide your PSC ID number.

Cooperative agreements do not cover general education courses. General education courses must be completed at PSC before receiving a cooperative agreement, unless you have already completed them elsewhere at the time of this application.

Have you completed or are you currently enrolled in any general education courses? Yes No

If you answered yes, where did you complete your general education courses? Please list any colleges you have attended in the past.

Cooperative Agreement Application Information

Please select one: Cooperative agreements can only be issued for current or future terms, not past terms. What term is the cooperative for? What is the name of the college you want to attend? What specific program do you want to pursue? Please provide a website link to the specific program:

Cooperative agreements only cover certificates and AAS degree programs (AA or AS programs and individual courses do not qualify). The specific program is a: Certificate Program Degree Program

Do you have an acceptance letter for this specific program? Yes No Not Applicable

If yes, please attach a copy along with this form below.

Attach any required documentation to support your application.

Transcript from past institution

Program acceptance letter

Additional Documentation