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PA Penn State York High School Dual Enrollment Form And Contract Of Understanding 2022
Get PA Penn State York High School Dual Enrollment Form And Contract Of Understanding 2022-2024
High School Dual Enrollment Form and Contract of Understanding A high school student registering for the first time at Penn State York as a dual enrollment undergraduate nondegree student must complete and return this form to the Penn State Admissions Office. U. Ed. YKO1751. The Pennsylvania State University encourages qualified persons with disabilities to participate in its programs and activities. Enrollment in the dual enrolment program does not imply admission to the University. The student must make formal application to be considered for admission as an undergraduate degree student. Select the appropriate responses regarding your ethnicity and your race 1. Is your ethnicity Hispanic/Latino Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin Yes Hispanic/Latino No not Hispanic/Latino What is your race select one or more White Asian Black or African American Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other/Multiethnic SECTION 4 Residency Status Are you a United States citizen Yes No If no which of the following statements describes your citizenship status I am an immigrant permanent resident residing in Pennsylvania. I have a nonimmigrant visa specific type Are you a legal resident of the Commonwealth of Pennsylvania Yes but less than one year Yes for more than one year No. SECTION 5 Contract of Understanding You must be a high school student in at least your junior or senior year to be eligible for this program. You must have a cumulative grade point average of a 3. SECTION 6 Signatures Student I have completed all applicable sections of this form and I affirm the accuracy of the information provided. Should there be any misinterpretation of the facts on this form I understand this may be cause of refusal or cancellation of my enrollment. Your individual information will be kept strictly confidential. The law only requires institutions to report aggregate totals for each category. Student Signature Date Parent/Guardian I have reviewed all applicable sections of this form and I affirm the accuracy of the information provided. I also am aware of my student s desire to participate in Penn State s Dual Enrollment Program and support their decision. High School Counselor/School Official I am aware of this student s desire to participate in Penn State s Dual Enrollment Program and support their decision. I believe he/she have the skills necessary to thrive in the college classroom and think this is a good opportunity for them. I am also aware of the student s graduation requirements and any role intended dual enrollment courses will serve. SECTION 1 Biographic Information Last Name First Name Middle Name Gender Male Female Date of Birth PSU ID Home Address Permanent Residence Street 1 City/State ZIP Student Email Address Parent Email Address I agree to allow Penn State to use email to communicate with me Phone Number to be contacted permanent -- Emergency Contact Name Phone Number SECTION 2 Educational Background and Goals Current High School Have you ever enrolled at Penn State NO YES 2017-18 Grade Level My high school counselor supports my desire to be a dual enrollment student NO YES Are you using this class to meet a high school graduation requirement NO YES If yes please explain What semester would you like to enroll in Fall Spring Summer What Year Are you currently in an academic drop status from Penn State or any other college or university previously enrolled NO YES Have you ever been denied admission to Penn State NO YES Are you planning to take courses to earn a degree If yes which academic program SECTION 3 Ethnic background Federal law requires that institutions of higher education gather the following information regarding the ethnicity and race of their students and employees.
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