What role best describes you?

Current High School Student

High School Educator

Parent/Legal Guardian of a Student

Parent/Legal Guardian Information

Parent/Legal Guardian Email

Parent/Legal Guardian Phone

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Are you interested in sharing information about a specific high school student considering dual enrollment coursework?

Yes

No

Student Information

Email Address

Verify Email

Student First Name

Student Last Name

Mobile Phone Number

Birthdate

Educational Information

High School Graduation Year

Please start typing your high school name and then select your high school from the list if it's available.

Current or Most Recent High School (please select from list)

Semester Planning to Complete Dual Enrollment Coursework

Year Planning to Enter College

In order to better serve you (and to send you printed materials), are you willing to provide us with more information?

Yes

No

Additional Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone (if different from mobile)

Biographical Information

Gender

Citizenship Information

US citizen

US permanent resident

Non-US citizen

If Non-US citizen, please select your country of citizenship

Are you Hispanic or 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:

Would you or a family member benefit from information in Spanish?

Yes

High School Educator Information

Educator Email

Educator Phone

Educator First Name

Educator Last Name

Current High School Name

Current High School Location

Country

City

Region

Postal Code

Educator Job Title

Do you have any specific questions or comments about dual enrollment?

By submitting this form, I agree to emails, phone calls and/or text messages from or on behalf of Messiah University Undergraduate Admissions at the email address and phone number provided on this form, including my mobile phone number. I understand that these communications may be generated using automated technology. I further understand that I can opt-out of these communications by emailing UNSUBSCRIBE to Admissions@messiah.edu.