Dual Enrollment Application

Enrollment Objective

Name

First

Last

Email

Confirm Email

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Citizenship

Birth Date

Gender

Ethnicity

Intended Enrollment Year

Enrollment Start Date

Traditional programs all begin Fall A, Spring A, or Summer

High School

High School GPA

Grade Level

Have You Made a Public Profession of Faith In Jesus Christ?

In the past 12 months, how often have you attended church?

Certify Application