Achieve - Dual Enrollment

Web

Dual Enrollment Application

Selected Round (Hidden)

Pre-selected major (Hidden)

Create New Round (Hidden)

Yes

Submitted Flag (Hidden)

Yes

Student First Name

Student Middle Name

Student Last Name

Suffix

Student Date of Birth

Please select the option that best describes the student:

If you would like the opportunity, we invite you to share more about your gender identity:

We ask for your child’s SSN to create a unique XULA student ID for them. This ID will follow them through all enrollments at XULA and allow us to make a permanent note of participation on their student record. All personal information is entered securely and stored in confidential XULA databases.
Please use numbers only and do not replace any digit with a letter. Failure to enter all 9 digits of a proper Social Security Number will delay your application process, or worse, cause a duplication or mismatch.

Social Security Number

Student Email Address

Student Mobile Phone Number

Student Home Phone Number (optional)

Student Address

Country

Street

City

Region

Postal Code

T-Shirt Size (Gildan Adult Unisex Sizing)

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.

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

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

Are you the dependent of a Veteran?

Yes

Academic and Financial Eligibility Information

Select the term you are planning to enroll in Achieve Dual Enrollment.

Name of High School you are currently attending

CEEB Code

Level of Study

High School Graduation Date

Current Grade Level

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

Yes

Please list. (Official transcripts may be requested)

Additional dual enrollment college, if applicable. (Official transcripts may be requested)

Have you ever attended any Xavier Pre-College Summer Programs?

Yes

Which Xavier Summer Program have you attended?

Achieve

BIOStar

Center of Excellence (COE)

ChemStar

LEAP

Magnificent Male

MATHStar

MATHStar II

SoarX

Star Sessions

Summer STEM Academy

Test scores are required for successful admission to Achieve Dual Enrollment. Any student who does not submit ACT or SAT scores, or does not have sufficient scores to show college readiness, will be required to take a placement test at Xavier University of Louisiana to determine their readiness for college courses. We strongly encourage students to submit their ACT/SAT test scores if they have them, even if they plan to take the test again to increase their score.

Have you taken the ACT or SAT?

Yes

ACT Composite score

ACT English Subscore

ACT Reading Subscore

ACT Math Subscore

ACT Science Subscore

SAT-R Total Score

SAT Reading and Writing Section Score

SAT Math Section Score

ACT/SAT Score Report Upload (Official or Unofficial)

Is the applicant a First Generation College Student (defined as, neither parent has completed a 4-year college or university degree)?

Number of household family members

Total household income

Please select the following services the applicant receives in school:

Free lunch

Reduced lunch

Neither

We want to hear about your barriers to accessing our Pre-College Program or other similar programs that may not be fully illustrated by your family income. Please provide any additional information that can help us assess your financial needs.

Upload verification of income. Acceptable documents include a tax transcript, tax returns, W-2, and/or 3 recent pay stubs. If these documents are not available or applicable to you, please contact Mavia Marsalis, Achieve Program Manager, for next steps (achievedualenrollment@xula.edu, 504-520-7018).

School Counselor Information

To complete your application, we require a letter of recommendation from your school counselor. Please request that your counselor send the letter to achievedualenrollment@xula.edu.

High School Counselor First Name

High School Counselor Last Name

High School Counselor Phone Number

High School Counselor Email Address

Xavier Relationship 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

Parent/Guardian Email Address

Parent/Guardian Phone Number

Parent/Guardian Address, if different from student:

Country

Street

City

Region

Postal Code

Additional Parent & Guardian Contact Information

Relationship Type

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email Address

Parent/Guardian 2 Phone Number

Parent/Guardian Address, if different from student:

Country

Street

City

Region

Postal Code

Achieve - Dual Enrollment

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