Achieve - Dual Enrollment

Web

Dual Enrollment Application

Selected Round (Hidden)

Pre-selected major (Hidden)

Create New Round (Hidden)

Yes

Submitted Flag (Hidden)

Yes

Prefix

First Name

Middle Name

Last Name

Suffix

Date of Birth

Sex

Home Phone Number

Mobile Phone Number

Permanent Address

Country

Street

City

Region

Postal Code

Email Address

Biographical Information

Information in this section is voluntary and will be used in a nondiscriminatory manner consistent with all civil rights laws. All applications for admission are considered without reference to sex, ethnicity, religion or handicap.

Ethnicity: Are you Hispanic/Latino?

Yes

Check one that best describe your Hispanic or Latino background.

Central America

Cuba

Mexico

Puerto Rico

South America

Spain

Check one or more that best describe your race.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islands

White

Religious Affiliation

Are you the dependent of a Veteran?

Yes

Academic Information

Select the term you are planning to enroll.

Name of High School you are currently attending?

CEEB Code

Level of Study

High School Graduation Date

Have you ever attended any other college or university for Dual Enrollment?

Yes

Please list. (Official transcripts may be requested.)

Have you ever attended any Xavier Summer programs?

Yes

Which Xavier Summer Program have you attended?

BIOStar

Center of Excellence (COE)

ChemStar

Chinese Immersion Summer Program

Exploring Computers Science at XU

Future Math and Science Teachers Academy (FMSTA)

LEAP

Magnificent Male

Mardi Gras Indians

MATHStar

MATHStar II

SOAR

SoarX

Star Sessions

Summer STEM Academy

Super Scholar EXCEL

Upward Bound

Have you taken the ACT or SAT?

Yes

ACT Composite score

SATR Total Score (EBRW + Math)

Is the applicant a First Generation College Student?

What is the applicant's household income

Parent/Guardian Information

Do you have any relatives who have attended Xavier?

Yes

Aunt

Brother

Cousin

Father

Grandparent(s)

Guardian

Mother

Multiple

Sister

Uncle

Please list names of relatives who have attended Xavier:

Parent/Guardian Contact Information

Relationship Type

Parent/Guardian first name

Parent/Guardian last name

Mobile Phone

Parent/Guardian email address

Parent/Guardian contact information.

Country

Street

City

Region

Postal Code

Achieve - Dual Enrollment

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