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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

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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.

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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

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1. Which Location do you plan to attend?

*

2. I plan to attend

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3. I plan to enroll in the following term

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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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