Dual Credit / Dual Enrollment Application

Personal Information

Student Contact Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip/Postal Code

Country

Email

All future correspondence from State Tech regarding your dual credit/dual enrollment admissions and registration will be sent to this email. We recommend that you copy this email and send to your HS Counselor.

Home Phone

Mobile Phone

Date of Birth

Gender

Country of Birth

Are you a U.S. Citizen?

YesNo

Are you a Permanent Resident?

Yes
No

Demographic Information

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 questions.

Are you Hispanic or Latino?

Yes
No

Regardless of your answer to the prior question, please select one or more of the following groups in which you consider yourself to be a member:

Parent / Guardian Contact Information

First Name

Last Name

Daytime Phone (with area code)

Relationship to you

State Residency Information

Are you a Missouri Resident?

Yes
No

When did you become a Missouri Resident?

Education Information

School Information

Name of School in which Dual Credit or Dual Enrollment class(es) will be taken

Expected Graduation Date

If you do not know month or date, use 06/01/2023.

What grade will you be in when taking your Dual Credit or Dual Enrollment classes?

Enrollment Information

When do you plan to take classes?

Fall 2024Spring 2025

Select a fall course to take:

(Optional) Select a 2nd course to take this fall:

(Optional) Select a 3rd course to take this fall:

Select a spring course to take:

(Optional) Select a 2nd course to take this spring:

(Optional) Select a 3rd course to take this spring:

Confirmation

By submitting this application,

I certify that all information contained in this application is true and complete and that no information has been withheld. I further understand that any incomplete or false information provided on this application may void my admission. I will request that my official transcripts be mailed to the State Technical College of Missouri Office of Admissions. In addition, I agree to the release of any transcripts, student records and test scores to State Technical College of Missouri including any ACT, SAT, and/or ACCUPLACER score reports that State Technical College of Missouri may request from ACT or College Board.
I agree to comply with State Technical College of Missouri’s computer acceptable use policy and all rules and regulations of the college as documented in the college catalog and student handbook, both of which are available at www.statetechmo.edu. I understand all items in my file may be shared with or reviewed by officials at my high school and/or career center as part of the dual credit/dual enrollment process at State Technical College of Missouri.
I understand that credit earned at State Technical College of Missouri through the Dual Credit/Dual Enrollment Program is transferable to other colleges and universities according to their respective transfer policies. Not all courses transfer to every college or university. Students are encouraged to contact the Director of Admissions or Registrar at the college or university of their choice to determine the acceptance and transferability of credit courses.

Non-Discrimination Policy

State Technical College of Missouri (State Tech) is committed to nondiscrimination and equal opportunities in its admissions, educational programs, activities and employment regardless of race, gender identity, gender expression, sex, sexual orientation, religion, color, national origin, age, disability, or status as a protected veteran to ensure nondiscrimination as required by Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX of the Education Amendments of 1972 (Educational Amendments, 20 U.S.C. §§ 1681-1688), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.§ 794), and Title II of the Americans Disabilities Act of 1990 (42 U.S.C. § 12101, et seq.)

If you have questions or complaints related to compliance with this policy, please contact Title IX Coordinator or Chief of Staff, One Technology Drive, Linn, MO 65051, (573) 897-5201, title9coordinator@statetechmo.edu; The Kansas City Office for Civil Rights may be reached at U.S. Department of Education, Office for Civil Rights, One Petticoat Lane, 1010 Walnut St., Suite 320, Kansas City, MO 64106. The telephone number is (816) 268-0550 and fax number is (816) 268-0559. The College’s full Nondiscrimination Policy can be found at www.statetechmo.edu on the College Catalog Policies page.

Student Social Security Number

If you do not know your SSN, then please leave blank.

Student Signature

Print your full legal name in the box above.

Parent or Guardian Email

Parent's/Guardian's email address cannot be the same as the student's. This email address will receive an email request to "approve" your participation in the State Technical College of Missouri's Dual Credit / Dual Enrollment Program. If you do not enter an accurate email address, your parent/guardian will not be able to approve your participation, and you will not receive State Technical College of Missouri credit.