Dual Credit Institute - Student Application

To apply for Bellarmine University's Dual Credit Institute as a high school student, start by completing this short application. Once your application is submitted, you will receive a confirmation email with details about the next steps.

For assistance, contact the Office of Admission at 502-272-7100 or dualcredit@bellarmine.edu.

Biographical Information

First Name

Preferred First Name (if different than your first name listed above)

Middle Name

Last Name

Email Address

Birthdate

Sex

Mobile Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Permanent Address

Same as Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Information

Relationship to Student

First Name

Last Name

Mobile Phone Number

High School Information

School Name

School Start Date

High School Graduation Date

High School GPA

High School Counselor Name

High School Counselor Email:

Course Registration

When do you plan to start your course?

Where are you taking Dual Credit courses?

For Bellarmine courses, search the Course Catalog and provide the course number and section below (e.g. ENGL 101 ON). Be sure to confirm that the requested course is available and has not reached capacity. Bellarmine does not offer a waitlist, and we may be unable to register you for a closed class. If the course requires a prerequisite, you must submit a copy of your college transcript showing that you have completed the requirement.

Please list the classes you would like to register for:

Please list the classes you would like to register for and include your 1st, 2nd and 3rd choice.

Additional Information

Primary Citizenship

Are you a permanent resident of the United States?

Yes

Current Visa Type (If unknown select "other")

The Social Security Number is requested for the purpose of record verification and mandatory state and federal reporting requirements for which the institution is responsible. It is also required of any student applying for financial aid and/or requiring 1098T for federal tax purposes. Your social security number will not be used as your primary student ID.

Social Security Number

Dual Credit Student Disclosure Agreement

Please read the Dual Credit Student Disclosure Agreement and then check the box below to acknowledge that you have carefully reviewed the agreement and understand the information provided.

I have read the Dual Credit Student Disclosure Agreement and understand the information provided.

Signature and Submit Application

Bellarmine University admits qualified students of any age, gender, gender identity, sexual orientation, race, disability, color, religion, and national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of age, gender, gender identity, sexual orientation, race, disability, color, religion, or national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school administered programs. Bellarmine University will not tolerate any form of sexual misconduct, which includes, but is not limited to, sexual harassment, non-consensual sexual contact, non-consensual sexual intercourse, sexual exploitation, rape or retaliation arising out of any of the above acts, as more fully defined in the Bellarmine Sexual Discrimination and Misconduct Policy in the Student and Employee Handbooks. Bellarmine University is an equal opportunity employer. The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name, this will count as your electronic signature.

Signature

Internal: UG Programs

Dual Credit Institute - Student Application

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