Dual Credit Student Enrollment Form

Student Name

First Name

Preferred First Name

Middle Name

Last Name

Maiden Name

Mailing Address

Country

Street

City

Region

Postal Code

(Hidden) Citizenship

Additional Contact Information

Home Phone

Cell Phone

Email Address

Biographical Information

Sex

Female

Male

Race/Ethnicity

Birthdate

SSN

Enrollment Information

Campus Selection

Intended Entry Term

Major Interest

High School Name

Graduation Date

How many Colleges/Universities have you attended or are currently enrolled?

Relationship 2

First Name

Last Name

Phone

Acknowledgments and Signature

Release of Necessary FAFSA/Financial Aid Information
I agree to allow Kentucky Wesleyan College to disclose FAFSA and Financial Aid-related information to the the below-indicated offices and related parties for the purpose of communicating with me and my family about financial aid eligibility and opportunities at Kentucky Wesleyan College.

You may withdraw your consent to disclose this information at anytime. A request to withdraw your consent should be emailed to finaid@kwc.edu from your personal or KWC email address.

Statement on Non-Discrimination
Kentucky Wesleyan College does not discriminate on the basis of race, color, sex, religion, handicap, age, gender preference, national or ethnic origin in the administration of our educational policies, admission policies, scholarship and loan programs, athletic activities or other school-administered programs or policies. As a church-related college, discrimination of any kind is incompatible with our educational mission.

Release of Information
Kentucky Wesleyan College, acting by and through its agents, is hereby authorized to release information about my admission/scholarships/honors/accomplishments to the media, including promotional materials distributed by Kentucky Wesleyan College to any media outlet. Additionally, I grant permission for my high school and any college/university to furnish all academic information requested by the Kentucky Wesleyan College Office of Admissions.

Contact
I acknowledge by clicking submit, I give Kentucky Wesleyan College permission to contact me using the included contact information including emails, calls and/or text messaging.

Attestation
I attest the information I have provided in this application is true and complete to the best of my knowledge. I understand false or incomplete information may void this application. If I am admitted, I agree to comply with all rules and regulations of Kentucky Wesleyan College.