Dual Credit Registration Form

High School Attending: *

High School Graduation Year: *

Do you wish to be considered for admissions to NLU in the Fall following your graduation from high school? *

Dual Credit Course: *

First Name: *

Last Name: *

Email: *

Phone:

Mobile Phone: *

Date of Birth: *

Address: *

City: *

State: *

Zip: *

Ethnic Background: *

Are you Hispanic/Latino: *

Gender: *

I confirm that I would like to be enrolled in a dual credit class with National Louis University *

Parent Information

Parent First Name: *

Parent Last Name: *

Parent Email: *