Dual Credit Program Application

Y

N

Current Term (hidden)

If the current month is 03, 04, 05, 06, 07, OR it is 08 and the current day is before 15: @current_term = 40
Else, if it is 08 and the current day is 15 or after, OR it is 09, 10*, or 11*: @current_term = 10
Else, if it is 01, 02, 12: @current_term = 30
Else, @current_term = 0

* Current Month 10/Current Day >= 15 or Current Month 11 require a PIN of 6279 (MARY)

Course Information

High School

(Other) High School Name

(C) = At BPS Career Academy
(O) = Online
(S) = At High School

Student Information

First Name

Middle Name

Last Name

Personal Email Address (non-school issued)

Mobile Phone Number

Home Phone Number

Birthdate

Social Security Number (omit dashes/spaces)

Current Mailing Address

Country

Street

City

Region

Postal Code

Anticipated High School Graduation Year

Anticipated College Start Term (optional)

Anticipated College Major (optional)