Dual Credit Application

Application Instructions

* Complete every question. Required fields are marked with *.

* Use the tab key or mouse to move through the fields.

* The form will automatically save when you move on to another tab by pressing the Next button.

* Once you submit your application, you will no longer have access to edit it.

* Do not use the back or forward buttons on your browser while in the app or it will be deleted, please use the next and previous buttons. 

Dual Credit Application

First Name:

Last Name:

Middle Name

Prefix:

Preferred Name:

Mobile Phone Number:

Parent/Guardian’s Phone Number:

Email Address:

Confirm Email Address:

Please enter your parent/guardian email address:

Dual Credit Application

Address:

City:

State

ZIP Code:

County:

Country:

Dual Credit Application

Gender:

Social Security Number

Date of Birth:

Marital Status:

Are you a citizen of the United States?

Ethnicity:

Race:

Dual Credit Application

High School:

Graduation Year:

For which session are you applying?

Will you be taking classes at our main campus, regional campus, or online?

Dual Credit Application

By checking the box, I agree to the following:

I understand NO TRANSCRIPT will be released until outstanding balance is PAID IN FULL.

I understand that if I withdraw from school before the course and/or term has ended, there will be no refund of payment.

By signing this document, I am certifying that I have read, understood and agreed to the terms established in this payment agreement with Campbellsville University. 

I allow Campbellsville University to send my grades to my high school so that they may be added to my high school transcript.

Tuition is based on the current allowable rate according to the policy set by KHEAA annually.

For fall semester, your invoice will be generated and sent on October 15.

For spring semester, your invoice will be generated and sent on March 15. 

In compliance with federal law, including provisions under Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, Campbellsville University does not discriminate on the basis of race, sex, color, nationality, or ethnic origin, age, disability, or military service in its administration of education policies, programs, or activities; admissions policies or employment.  Under federal law, the University may discriminate on the basis of religion in order to fulfill its purpose.

I certify that the information herein is complete.  I understand that my admission and subsequent registration may be cancelled if this information is found to be false or intentionally omitted.  If I enroll at Campbellsville University, I agree to familiarize myself with all the rules and regulations of the University and abide by them.