Dual Enrollment Application

Personal Information

Name

Address

City

State

Zip

Phone

Home:

Cell:

Email

Date of Birth

Gender

Male Female

EDUCATIONAL INFORMATION

High School:

High School City:

High School Type:

Year of Graduation:

Academic year applying for: *

Have you previously been a dual enrollment student?:

Yes No

(If you have previously attended another college/university other than MVNU, please include the name of the school and mail an official transcript from that institution.)

What institution(s) are you considering for your four-year degree?:

1:

2:

3:

4:

What is your intended college academic major?:

1:

2:

ANTICIPATED CLASS LOAD *

Your best guess on how many MVNU classes you anticipate taking over the course of the year

1–3 classes (3–9 college credit hours)

4–7 classes (10–21 college credit hours)

8–10 classes (24–30 college credit hours)

PROGRAM FORMAT *

On-Campus Commuter – The student will travel to MVNU for each class.

On-Campus Residential – The student will live on campus (Available only to high school seniors who are taking a minimum of 12 credit hours per semester. Room and food service charges apply.).

Online Only – The student will not attend classes at MVNU, and will only be enrolled in courses with online instruction.

On High School Campus – The student will be enrolled in MVNU classes at one of our designated Partner Schools.

PAYMENT PROGRAM *

College Credit Plus – This State of Ohio program covers 100% of tuition, fees, and books for qualified students for up to 30 college credit hours.

Family Pay – This MVNU program allows students who are not eligible for Ohio’s College Credit Plus program to take dual enrollment courses at ¼ the published full-time and part-time rates.

Combination – The student has limited College Credit Plus funding but would like to use the Family Pay option to take additional courses at the student’s cost.

The following information is not necessary for admission to Mount Vernon Nazarene University.
However, it is valuable for statistical purposes and for local, state, and/or federal reports. Completion of this section is by choice.

Church Name

Church City

Church Denomination

Race/Ethnicity:

Are you Hispanic or Latino? Yes No
If not, select one or more of the following:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White

CONSENT *

Participation in MVNU’s Dual Enrollment Program requires consent from a parent (or legal guardian) and your high school guidance counselor. Please provide name and email addresses for both.

Parent/Guardian Name:

First

Last

Parent/Guardian Email Address:

This is my...

Parent Guardian

Guidance Counselor Name:

First

Last

Guidance Counselor Email Address:

I’m homeschooled and don’t have a guidance counselor (Type “n/a” above).

STATEMENT OF INTENT *

I wish to be a dual enrollment student at Mount Vernon Nazarene University. I understand that

Admittance into the program is contingent on submission of all forms by April 1.
I will not be allowed to begin classes unless I participate in Dual Enrollment Orientation over the summer (not required for students only taking courses at their high school).
Class enrollment is contingent on available class space.
A complete transcript through the end of the prior school year must be received by MVNU before I will be allowed to register for classes.

Student Signature:

Date:

DUAL ENROLLMENT APPLICATION