Dual Credit Registration Form
High School Attending:
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-- Select --
CURIE METRO HIGH SCHOOL
SIMEON CAREER ACADEMY
JUAREZ COMMUNITY ACADEMY
Curie Metro High School Teacher:
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-- Select --
Bell
Rake
High School Graduation Year:
*
Do you wish to be considered for admissions to NLU in the Fall following your graduation from high school?
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-- Select --
Yes
No
Semester:
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-- Select --
Fall
Spring
Dual Credit Course:
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Select a high school and semester to see available courses.
First Name:
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Last Name:
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Email:
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Primary Phone:
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Date of Birth:
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Address:
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City:
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State:
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Select A State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Ethnic Background:
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-- Select --
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Chose Not to Respond
Are you Hispanic/Latino:
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-- Select --
Yes
No
Gender:
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-- Select --
Male
Female
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:
*
