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Dual Enrollment Application
Dual Enrollment Application
Students: Please fill out the top portion of the application. You will need to obtain
your counselor or principal's email address!
Once you submit the form, we will also need a copy of your high school transcript
that can be sent to ludualenrollment@lourdes.edu. We will also need additional paperwork that will be sent to you in a separate email. You, your parents, and your school counselor will need to sign. They will also receive these via email.
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Student Type
Dual Enrollment-High School
Round always create
Yes
Round
Dual Enrollment-High School
Dual Enrollment Student Type
College Credit Plus
High School Scholars
When would you like to start classes at Lourdes?
Fall 2024
Summer 2024
What pathway(s) are you interested in?
What pathway(s) are you interested in?
Nursing
Education
Sciences
Business
General Education Courses
Student Information
Personal Email Address
(
please do not use your school email as they often block external emails
)
First Name
Middle Name
Last Name
Mobile Phone Number
May we text you?
May we text you?
Yes
No
Birthdate
Birthdate
January
February
March
April
May
June
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November
December
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1911
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1901
1900
Gender
Female
Male
Other
Shirt Size
Small
Medium
Large
Extra Large
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Ethnicity and Race
Are you Hispanic or Latino?
Are you Hispanic or Latino?
Yes
No
Please select your race(s). Choose all that apply
American Indian or Alaska Native
Asian
Black or African American
Hispanic
Native Hawaiian or Other Pacific
White
Student High School Information
Name of Current High School
(Please choose from the dropdown list)
Year in High School
Middle School
Freshman
Sophomore
Junior
Senior
Anticipated High School Graduation Year
2022
2023
2024
2025
2026
2027
2028
School Counselor or Principal First Name
School Counselor or Principal Last Name
School Counselor or Principal Email Address
School Counselor or Principal Phone Number
Parent/Guardian Information
Relationship Type
Father
Mother
Step-Father
Step-Mother
Legal Guardian
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email Address
Parent/Guardian Mobile Phone Number
Student Signature
I agree to abide by the Community Standards Code Policy, available on the Lourdes University website (https://www.lourdes.edu/campus-life/public-safety/community-standards-student-conduct/community-standards-code-policy/)
I also authorize the release of grades earned at Lourdes University to my current high school.
By adding my full given name and initials below, I verify the above
information to be true and accurate to the best of my knowledge.
Date of Signature
Date of Signature
January
February
March
April
May
June
July
August
September
October
November
December
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*Upon acceptance, participation for non-public high school students is dependent upon
approved credit hours and availability of funding through the Ohio Department of Education.
Select List: Generate PIN (hidden)
Yes
Submitted Flag
Yes
Submit
