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  - Penn Highlands Academy Application
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Dual Enrollment Application

Get help using 'Dual Enrollment Application'

Introduction
Student
Address
Demographics
Parents
High School
Completion

Dual Enrollment Accelerated College Education (ACE) Application

Welcome to the Pennsylvania Highlands Community College Accelerated College Education (ACE) Application. This application is for students who plan to enroll in courses offered through their high school.

When completing this form, all required fields must be completed in order for your application to be submitted.

After you have submitted your completed application, you will receive a message to let you know that your application has been sent.

Questions regarding the ACE Program or the enrollment process can be directed to the ACE Help Line at 814-262-6444.

NOTE: When continuing to the next page of the form use the Next Button to continue to the next page or the Previous Button to return to a previous page. Do not use the browsers Forward > or Backward < buttons, you will receive an error message and will need to begin over.

Student Information

First Name

Middle Name

Last Name

Email Address

Confirm Email Address

(Essential enrollment and payment information will be sent to the email address provided on this form)

Address Information

Street

P.O. Box

City

State

Zip Code

County

Primary Phone Number

Cellular Phone Number

Demographic Information - ( Optional )

The completion of the following information is voluntary and optional. It will be used to comply with Federal reporting and has no effect on admission to the College. Pennsylvania Highlands Community College is committed to the principle of equal education for all students without regard to race, national origin, marital status, creed, gender, age, or handicap.

Gender

Male
Female

Birth Date

Social Security Number

Race Information

Race (Choose 1 or more)

White
Native Hawaiian or Other Pacific Islander
Black or African American
Asian
American Indian or Alaska Native

Ethnicity

Not Hispanic/Latino
Hispanic/Latino

Parent/Guardian Information

Parent/Guardian First/Last Name

Parent/Guardian Street

Parent/Guardian P.O. Box

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Zip Code

Parent/Guardian Primary Phone Number

Parent/Guardian Secondary Phone Number

Parent/Guardian Email Address

Do you authorize the above listed Parent/Guardian consent to access your academic records?

The Family Educational Rights and Privacy Act (FERPA) of 1974 protects the privacy of educational records. By selecting YES, I, the student agree to the release of my academic and billing/account information to the Parent/Guardian listed on this application. I understand that I can change this access at any time by contacting the Registrar's Office.

Do you authorize the above listed Parent/Guardian consent to access your academic records?

High School Information

What High School do you attend?

What year will you graduate?

Completion

Electronic Communication

The College may communicate with you in a variety of ways including email and text messaging. Please indicate below if you would like to opt out of receiving text and/or email messages from Pennsylvania Highlands Community College.

I wish to receive emails from Pennsylvania Highlands Community College.

Sign and Submit

By entering my first and last name, I certify that all information reported on this form is complete and accurate to the best of my knowledge.

Student Signature

Date

*MISSING[JCF_TXT_DATE]*

Student Country

Parent Country