Dual Admission Intent Form

NOTE: This Dual Admission intent form is NOT the same as the application for admission to Millersville University.
If you are interested in a completely online program with us, DO NOT fill out this intent form.

______________________________________________________________________

Personal Info

First Name

Middle Initial

Last Name

Preferred First Name

Birthdate

Email Address

Home Phone Number

Mobile Phone Number

May we text you?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Gender

Primary Citizenship

Ethnicity

Are you Hispanic or Latino?

Yes

No

Are you a Pennsylvania resident who has lived in the state for more than 12 months?

Yes

No

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Dual Admissions Info

When do you expect to enter Millersville University?

Intended Major

______________________________________________________________________

Community College Info

Community College

CEEB

Level of study

Community College Student ID#

Start Date

Expected Graduation Date

High School from which you graduated

______________________________________________________________________

Signature

Students may apply for admission under the Dual Admission Program as early as their senior year of high school but no later than the completion of 30 college-level credits in a transfer program offered through their community college(s).

Students enrolled in the Dual Admission Program must maintain continuous enrollment at their current community college, earn the associates degree and meet all Millersville admissions requirements, including grade point average for their intended major.

Please inform your community college and Millersville of any changes in your plans and update relevant personal information. If you attend another college/ university in addition to your current community college to complete college credits, you must request an official transcript(s) to be sent directly to Millersville.

I authorize my current community college, which I have indicated on this form, and Millersville to exchange necessary information regarding my matriculation and course work, including academic transcripts, at both institutions to facilitate the transfer from my current community college to Millersville and to provide the information needed to evaluate the program. Such information will be reported in summary form so that no student will be identified individually.

Millersville University of Pennsylvania, in compliance with federal and state laws and university policy, provides equal educational, employment, and economic opportunities for all persons without regard to race, gender, age, ethnicity, national origin, religion, sexual orientation, or marital, veteran, or disability status. Direct requests for disability accommodations and other inquiries should be made to the Office of Learning Services, Millersville University PO Box 1002 Millersville, PA 17551-0302, 717-871-5554

Today's Date

In place of signature, please type your full name: