Please complete this Dual Enrollment application fully. Once submitted, the program coordinator will reach out for additional information, and to update you on the progress of your application. Thank you for your interest in Dual Enrollment opportunities at Westfield State University!
Term (Choose which term you are applying to register for a course)
*
Fall
Spring
Summer I
Summer II (CDEP funding not available for this term)
Year
*
Student Information
Last Name
*
First Name
*
Middle Name
Date of Birth
*
Gender
Male
Female
Non-binary
Street Address
*
City
*
State
*
ZIP code
*
Home Phone
Cell Phone
*
Email Address
*
Parent Information
Last Name
*
First Name
*
Street Address (if different from student's)
City
State
ZIP code
Cell Phone
*
Email Address
*
High School Information
Name of Highschool
*
SASID (Student ID available from Guidance Office)
High School Phone
*
School Counselor Name
*
School Counselor Email
*
Grade while taking this course
*
Freshman
Sophomore
Junior
Senior
Expected Year of Graduation
*
For data reporting purposes, and to assist us in providing equitable access to grant funding, please answer the following questions.
Do you receive free/reduced lunch?
Yes
No
Did your parents or grandparents graduate from college?
Yes
No
Are you interested in Science, Technology, Engineering, or Math (STEM disciplines)?
Yes
No
