Dual Enrollment Counselor Connect Form

Student Last Name

Student First Name

Student Email Address

Student Expected Year of Graduation

Student Birthdate

Student Course Information

My student would like to enroll in the following classes:

Student High School Counselor Information

Name of High School

School Counselor First Name

School Counselor Last Name

School Counselor Email Address

By adding my full legal name below, I verify that the above named student is in good standing in their high school and meets the minimum standards of the Lourdes University Dual Enrollment Program.

*3.0 GPA (*If the student is below, but close, please use your discretion on your recommendation)
Readiness to participate in college-level courses

I give my permission to dual enroll the above named student.