High School Dual Credit Application

Student Information

First/Given Name

Preferred First Name Learn More

Middle Name

Last/Family Name

Birthdate

Legal Sex

Gender Identity

Other:

Appropriate Pronouns

Other

Primary Citizenship

Academic Information

Current High School

CEEB Code

Level of Study

Current Class Year

High School Graduation Year

Current GPA

School Counselor's Name

When will you be enrolling in your dual credit course(s)?

Course(s) youre interested in taking through Valparaiso University
See courses available

Major

Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Mobile Phone Number

By checking this box, you agree to receive occasional text messages from Valpo about events, application deadlines and scholarship reminders.

Yes

Parent/Guardian Information

Parent/Guardian 1

First Name

Last Name

Relationship

Parent/Guardian 2

First Name

Last Name

Relationship

Is either parent an alumnus/alumna?

Signature

Have you ever been suspended from any school or do you have any disciplinary charges pending?

Yes

No

Please explain:

Have you ever been convicted of a felony or do you have a felony charge pending?

Yes

No

Please explain:

I confirm that I have read and understand the Valparaiso University College Experience Dual Enrollment Program Student & Parent Guardian Agreement Form.

Yes

No

Upload a copy of your unofficial high school transcript:

By submitting this application, I agree that any information furnished to Valparaiso University, at any time and regardless of whether or not I am accepted as a student at Valparaiso University, including all information and materials of any kind received by Valparaiso University from any sources or prepared by anyone at its request, shall not be disclosed to anyone, including myself, except that an authorized official at the University may at his or her discretion, for official purposes, disclose any or part thereof to another such person as is necessary. I certify that all information on my application is complete, factually correct and honestly presented. I also grant permission to any high school(s) or college(s)/university(ies) I have attended to release my transcript(s) to Valparaiso University.

In place of your signature, please type your full legal name:

Date

Parent/Guardian Signature (If you are under age 18, a parent must also sign.)

Date

Valparaiso University admits students of any race, color, national or ethnic origin, age, gender, disability, sexual orientation, or religion.

Entry Status

Round

Round Creation

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