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Non-Degree Admission Application for
Whittier High School Dual Enrollment
Personal and Demographic Information
Full name
*
First Name
*
Middle Name
*
Last Name
*
Suffix
*
Previously attended Whittier College?
*
Yes
No
Student ID
*
SSN
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Email
*
Phone
*
Date of Birth
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Gender
Male
Female
Non binary
Citizenship Status
US Citizen or US National
US Dual Citizen
US Permanent Resident
US Refugee or Asylee
Non-US
Are you Hispanic or Latino
Yes
No
Prefer not to answer
Please indicate how you identify yourself (Select one or more)
American Indian or Alaska Native
Asian
Black or African American
Caucasian
Native Hawaiian or Other Pacific Islander
Home School Consent
Upload a signed statement of support from the principal of the student's high school. The statement should be written on school letterhead.
*
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Parent/Guardian Consent
The parent/guardian consent must include the following:
The following statement: "As the parent or legal guardian of this student I approve of their dual-enrollment in Whittier High School and Whittier College. I authorize the faculty and staff with a legitimate education interest at Whittier High School and Whittier College to exchange the student's confidential and personally identifiable information including grades and test scores."
The parent/guardian's relationship to the student
The parent/guardian's name
Parent/guardian signature
Date
Upload the parent/guardian statement of consent
*
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Registrar Review
Semester
Fall
Spring
Year
Subject
CRN
Number
Course Title
Reviewed by
*
Send for academic department approval to (enter email)
*
Academic Department Approval
Decision
*
Approved
Not Approved
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