High School Dual Enrollment Application

First Name (Given)

Middle Name

Last Name (Family)

Suffix

Birthdate

Social Security Number (Optional) - Omit dashes

Contact Information

Mobile Phone

Would you like to receive text messages from Detroit Mercy?

No

Yes

Email Address

Address Information

Mailing Address

Country

Street

City

Region

Postal Code

Is your permanent address different from your mailing address?

Yes

No

Permanent Address

Country

Street

City

Region

Postal Code

Permanent Address

Same as Mailing Address

Country

Street

City

Region

Postal Code

Biographical Information

Sex

Male

Female

Other

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino?

Yes

No

Race

Primary Citizenship

Are you a US Permanent Resident?

Yes

No

Permanent Resident Card Number

High School Information

Once you submit this application, a required High School Assessment Form will be sent to your high school counselor.

High School

CEEB (Internal)

High School Graduation Year

High School Counselor First Name

High School Counselor Last Name

High School Counselor Email

Parent Information

Once you submit this application, a required Parent Consent Form will be sent to your parent or guardian.

Parent Relationship

Parent First Name

Parent Last Name

Parent Mobile Phone

Parent Email Address

Dual Enrollment Information

Which class type are you interested in taking?

Are you interested in a second course? (Optional)

Which term are you applying for?

Fall

Where are you planning on taking your class(es)?

At my high school

On campus at University of Detroit Mercy

Online

Click to Sign...

Create App (Internal)

Yes

Submit App (Internal)

Yes

Student Status (Internal)

Dual Enrolled