Dual Enrollment Application Form

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Staff Assigned (Hidden)

Record Level (Hidden)

Round Create? (Hidden)

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Program - Partner Schools 200 (Hidden)

Program - Partner Schools 150 (Hidden)

Program - NON Partner Schools (Hidden)

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Application Source (hidden)

The application below is for high school students that are wanting to take dual enrollment Mississippi College (MC) courses offered at one of MC's partnering high schools. Students filling out this dual enrollment application must be enrolled at one of these high schools: Clinton High School, Jackson Prep, Madison Ridgeland Academy, Tupelo Christian Preparatory School, St. Joseph Catholic School, or St. Augustine School. Your submission of this form will make you eligible to be a non-degree seeking, dual enrollment student at MC. To be ready to register for the course(s), MC will also need your high school transcript, standardized test scores, and your signed Dual Enrollment Agreement Form.

Biographic Information

Legal First Name

Preferred Name

Middle Name

Last Name

Birthdate

Gender

What is your citizenship?

Social Security Number

Race

Are you a permanent resident?

Contact Information

Email Address

Cell Phone Number

May we text you at this number?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Additional Information

What high school do you currently attend?

My High School is Not Listed

My High School is Listed

School Name

CEEB (hidden)

High School - Clinton High School (hidden)

Ceeb Code - Clinton High School (hidden)

High School - Jackson Preparatory School (hidden)

Ceeb Code - Jackson Preparatory School (hidden)

High School - MRA (hidden)

Ceeb Code - MRA (hidden)

High School - Saint Joseph Catholic School (hidden)

Ceeb Code - Saint Joseph Catholic School (hidden)

High School - Saint Augustine School (hidden)

Ceeb Code - Saint Augustine School (hidden)

High School - Tupelo Christian Preparatory School (hidden)

Ceeb Code - Tupelo Christian Preparatory School (hidden)

High School - Starkville Academy (hidden)

Ceeb Code - Starkville Academy (hidden)

Level of Study (hidden)

When would you like to start as a Dual Enrollment student at Mississippi College?

Emergency Contact Information

First Name

Last Name

Phone Number

Email

Relationship to Student

Is this person over the age of 18?

Yes

No

Application Agreement

By clicking "yes" to the prompt below, you are stating that the above information is truthful and accurate.

Yes

Please type your full name in lieu of a signature.