Dual Enrollment Application

Personal Information

Student First Name

Student Last Name

Do you have a preferred name you would like to provide?

Student Preferred Name (Enter ONLY if different from your first name above).

Student Personal Email Address
*Please use a personal email. School accounts may block incoming messages and interfere with Multifactor Authentication.

Student Birthdate

Enter your U.S. Social Security Number (SSN)
If you have been issued a U.S. Social Security Number, you may provide it. This is optional and used for matching financial aid and university records.

Sex

Are you a Pennsylvania state resident?

Yes

No

Student Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

How many years have you been a permanent full time resident in Pennsylvania? (0-100) If less than 1 year please enter 0.

Primary Citizenship

What is your official state of Permanent Residency, if residing in the United States?

Course Selection

What term do you plan to take classes?

All summer courses are only available online.

Which location/modality do you prefer for your classes?

How many classes would you like to take?

Please provide your class choices in order of preference.

Preferred Class Choice 1

Preferred Class Choice 2

Preferred Class Choice 3

Preferred Class Choice 4

Preferred Class Choice 5

Preferred course not listed? Tell us what you're looking for.

Educational Information

What school do you currently attend? (Start typing your school name and pick from the dropdown.)

What year do you graduate high school?

High school counselor’s name (if known)

When you attend college full time, what will be your intended major? (Select One)

Concentration (Select One)

Parent/Guardian Information

Please provide parent/guardian information for communication purposes.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Would you like to:

Add another parent/guardian

Parent/Guardian Last Name

Parent/Guardian First Name

Parent/Guardian Email Address

Material Uploads

Your application is incomplete without the following forms completed and uploaded here:
Financial Terms & Conditions Agreement (download form)
Authorization Form (download form)

Transcripts must be sent from your high school by request to admissions@pennwest.edu.

Financial Terms & Conditions Agreement

Authorization Form