High School Dual Enrollment Application

Name Name First Last
Please provide legal name.
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email

Please enter your school email given to you by your high school.
Date of Birth Date of Birth / MM / DD YYYY
KSBE Student ID Number
Must be 7 digits. Currently Entered: 0 digits.
High School Name
School CEEB Code
High School City
High School State
Anticipated Year of High School Graduation
Enroll In HPU Dual-Credit Courses Starting Term
Have you previously applied or taken/taking any classes at HPU?
HPU Provided Email
HPU Student ID
Maximum of 9 characters allowed. Currently Entered: 0 characters.
Starts with @
Example @23456789
Citizenship
Country of Citizenship
Are you Hispanic or Latino?
Select One or More of The Following Races

Select One or More of The Following Races American Indian or Alaska Native Asian Black or African American Hawaiian Native; Part or Mixed Hawaiian Other Pacific Islander White
Gender
Comments
Academic Program
Banner Attribute
Banner ID
Must be 9 characters. Currently Entered: 0 characters.
Include @
Level
Student Type
Action
Notes
Submission Status