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Dual Enrollment Application

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High School Dual Enrollment Application

Welcome to the Pennsylvania Highland Community College Dual Enrollment Application. This application is reserved for high school junior and senior students who are enrolling in a college course(s) at a Pennsylvania Highlands location, or an online course.

In addition to completing the Dual Enrollment Application, prospective students must also submit a recommendation from their high school principal or guidance counselor. This process must be repeated for each semester in which a student intends to enroll while in high school.

 

All required fields must be completed in order for your application to be submitted.

After your form has been completed please review for errors and then click the submit button.  You will receive a message indicating that your application has been submitted.

Questions regarding the application or the enrollment process can be directed to the Admissions Office at 814-262-6446.
 
  

General Information
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First Name
 

Middle Name
*

Last Name
*

Email Address
*

Confirm Email Address
 
  

Address Information
*

Street
 

P.O. Box
*

City
*

State
*

Zip Code
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County
 

Country
Residency Requirements

Tuition rates at Pennsylvania Highlands Community college are established by a student's residency. The Residency Policy can be found in the College Catalog.
*

How long have you lived at this address?
 

If less than one year, enter prior county and state of residence:
*

Primary Phone Number
 

Cellular Phone Number
 

Work 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
 

Birth Date
 

Social Security Number

Citizenship Information
 

Country of Citizenship
 

Citizenship Status



Race Information
 

Ethnicity

 

Race (Choose 1 or more)




 
  

Educational Goals
*

1. Which Location do you plan to attend?
*

2. I plan to attend
*

3. I plan to enroll in the following term
*

4. I plan to enroll in the following year
 
  

High School Information
 

Name of High School
 

City
 

State
 

Zip Code
 

Year of High School Graduation
 
  

Emergency Contact Information
 
  
 

Name of Person to Contact in Case of an Emergency
 

Contact Phone Number
 
  

Completion

How Did you Hear about Pennsylvania Highlands?
 

How Did you Hear about Pennsylvania Highlands?
 
  

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.
*

I wish to receive text messages from Pennsylvania Highlands Community College.
 
  

Sign and Submit

By entering my name, I acknowledge that I have made application to Pennsylvania Highlands Community College and certify that the information provided on the application is true to the best of my knowledge.
 

Signature
 

Date
 
  
 
  
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