Spring High School Dual Enrollment Form

High School Information

What term do you want to take a class/classes?

Homeschool or Cyberschool?

Yes

If yes, in what school district do you reside?

After graduation from high school, when do you plan to attend college?

Please indicate what major you plan to pursue in college.

High School Name

Please select your assigned high school Dual Enrollment Coordinator.

Hempfield: Ms. Kimberly Romero; kimberly_romero@hempfieldsd.org

Penn Manor: Ms. Dana Wile; dana.wile@pennmanor.net

McCaskey: Mr. Thomas Toczek; trtoczek@lancaster.k12.pa.us

Ephrata: Ms. Kerri Batdorf; k_batdorf@easdpa.org

Solanco: Ms. Lindsay Capoferri; lindsay_capoferri@solanco.k12.pa.us

Conestoga Valley: Mr. Jerry Wyble; jerry_wyble@conestogavalley.org

Elizabethtown: Dave Gibbs; david_gibbs@etownschools.org

** If your high school is not listed or if you do not know who your Dual Enrollment Coordinator is, please list the name and email address of your High School Counselor.

High School Counselor

High School Counselor Email Address

Upload High School Transcript (Required)

** If your SAT or ACT scores are not listed on your high school transcript, please upload your score report from the College Board or ACT below.

Do you have SAT/ACT scores?

Upload SAT/ACT Score Report

Course Selection

Students should only apply for courses they wish to enroll in.

Students: you must select your course(s) from the Approved Dual Enrollment Course list
*You will need to select the term you wish to apply for from dropdown.(e.g. Fall 2020)
**We will be unable to accommodate request for courses that are not on the approved course
*** The Approved Dual Enrollment Course list is also available on the Undergraduate Admissions website.

Course 1 CRN

Course 1 Lab CRN (only if course required)

Course 1 Recitation CRN (only if course required)

Course 2 CRN

Course 2 Lab CRN (only if course required)

Course 2 Recitation CRN (only if course required)

***Important Information - If you wish to register for additional courses, please email the Undergraduate Admissions office at admissions@millersville.edu

Click here for Millersville University transcript request form.
** You must fill out this form and submit it to the Registrar’s office at Millersville in order for your final grades to be released to you and/or your high school. Please complete and submit immediately after applying for Dual Enrollment.

I provide consent to Millersville University to release my education records to my parents and current high school administrators, including scheduling information, transcripts/grade reports, and other academic records related to my status as a dual enrolled student. I understand this information will be released verbally and in written education records. I have the right to inspect any education records released. I understand I may revoke this consent at any time by contacting the Millersville University Registrar's Office.

Yes

Additional Information

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution.

Yes

If yes - Please give the approximate date(s) of each incident, explain the circumstances and reflect on what you learned from the experience. You may use up to 400 words.

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Yes

If yes - Please provide the details of your criminal conviction or adjudication and reflect on what you learned from the experience. You may use up to 400 words.