This form must be completed in its entirety to create a cooperative agreement/chargeback request. Please
- You must provide proof of current residency (valid Illinois driver's license or state ID card)
- For competitive admission programs, you must provide proof of acceptance into the program
Application Deadline Dates: Applications received after the due date will be denied.
- Fall Semester: July 25
- Spring Semester: December 16
- Summer Semester: April 20
Note: No new chargeback authorizations will be given for Dental Hygiene at Parkland College. Dental Hygiene
is offered at 4 cooperative colleges and authorizations will only be given to these schools.
(If you do not know your JJC Student ID Number, see the ID/Username/Password Help page.)
Cooperative Agreement/Chargeback Information
Provide your Cooperative Agreement/Chargeback information in this area, such as the college you will be attending, and the program name.
Note: If you are requesting authorization for a selective admission program such as: Sonography,
Physical Therapy Assistant, Respiratory Therapy Assistant, Dental Hygiene, and others, you must
provide a copy of your letter of acceptance into the program. NO authorizations will be given
without proof of acceptance into a program.
Note: Authorization is for an entire academic year. If you need a longer period of time to
complete your program of studies, you will need to renew your Cooperative Agreement/Chargeback
before the required deadline. Authorization years are valid beginning with the summer term.
I certify that all information in this request is true and correct. I understand
that Joliet Junior College is not obligated to pay the out-of-district tuition for
any course I take which does not directly apply to the approved program.
Approval will be emailed back to you. It is the student's responsibility to submit the
original of the approval form to the attending college. If you prefer a paper copy mailed to
your home address, please indicate that in the space below.
Questions or concerns: call (815) 280-2533
- Print and Mail to the following address:
Outgoing Chargebacks - Academic Affairs
Joliet Junior College
1215 Houbolt Rd., Joliet, IL 60431
- Print and Fax to: (815) 280-2295