CCHS Application

* indicates required field

Round: CCHS (HIDDEN)

Round Always Create (HIDDEN)

Generate Pin (HIDDEN)

Submitted Flag (HIDDEN)

Submitted Date (HIDDEN)

Student Type: Non-Degree (HIDDEN)

Program: College in High School (HIDDEN)

Contact Information

First Name*

Middle Name

Last Name*

Email Address*

Parent Email Address*

Birthdate*

Gender

Mailing Address*

Country

Street

City

Region

Postal Code

Phone Number

Personal Information

Country of Citizenship*

Are you a Permanent Resident of the United States?

Yes

No

Social Security Number (if available)

Many groups, including the government and accrediting agencies, ask universities to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Education

Please list the names of your current high school:

High School*

Are you currently a*

Please upload a copy of your transcript.

Additional Information

When do you plan to enroll?*

What class or classes are you interested in?

Criminal Charges

Are there any criminal charges presently pending against you other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University.)*

Criminal Charges

Are there any criminal charges presently pending against you other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University.)*

Yes

No

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Conviction Charges

Have you ever been convicted, pled guilty or no contest to a crime other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University).*

Conviction Charges

Have you ever been convicted, pled guilty or no contest to a crime other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University).*

Yes

No

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Please provide a brief statement as to what inspired you to take college courses at Duquesne University.*