High School Dual Enrollment Nondegree Application

Name

PLEASE READ CAREFULLY:

Applicant must be a junior or senior in high school.
Applicant must have a 3.0 cumulative grade point average.
Applicant must meet with an admissions counselor prior to registration.
Nondegree-seeking students are not eligible for federal or state financial aid or academic advising.
A maximum of 30 credit hours may apply toward an undergraduate degree.

Legal First/Given Name

Middle Name

Last/Family/Surname

Former Last Name (if any)

Biographical Information

Social Security Number

Birthdate

Sex

Birth Country

Citizenship

Primary Citizenship

Residency Status

Permanent U.S. Resident

Alien Registration Number

Current Visa Type

Permanent Address

Country

Street

City

Region

Postal Code

Contact Information

Home Phone

Mobile Phone

Would you like to receive text messages from GVSU?

Email Address

Personal Background

US Military Service (Please check all that apply):

Do you currently live in the United States?

Yes

No

In what state do you claim residence?

County of Residence

How long have you lived in Michigan?

Fewer than 6 months

More than 6 months

Do you consider yourself Hispanic/Latino?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Have either of your parents graduated from a four-year college?

Yes

No

Criminal Charges

Have you ever been convicted of a felony or have you been arrested for a crime for which criminal charges are pending?

Yes

No

You must enter additional information explaining the nature of the crime, relevant facts, and the name, address, and telephone number of your corrections officer. You may be required to meet with an admissions representative before a decision on your application will be made. You may be dismissed from GVSU if you fail to indicate such felony convictions or pending charges.

Please provide additional information:

Enrollment Plans

Intended Semester for this class:

Have you ever enrolled in any Grand Valley course(s)?

Yes

No

When do you plan to enroll in college full time

High School

Please list the high school from which you graduated (or will graduate):

High School Name

CEEB (hidden)

Level of Study (hidden)

High School Coursework

Degree

Attended From:

Attended To:

Graduation Date (actual or planned)

Dual Enrollment Partnership Program

Are you participating in one of the GVSU Dual Enrollment Partnerships listed above?

Yes

No

Please select the Dual Enrollment Partnership Program you are participating in

Signature

You are not required to give your Social Security number, date of birth, sex, or racial/ethnic group, or to acknowledge the existence of a handicap or disability. This information is used for compiling institutional data. It is not a factor in admissions. Your signature is required before GVSU can process this application.

I certify that all the answers I have given on this form are complete and accurate to the best of my knowledge. I understand that withholding information requested on this application will make me ineligible for admission to the university, or subject to dismissal.

Signature

Admissions & Recruitment

High School Dual Enrollment Nondegree Application

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