Dual Credit Student Registration

Welcome to the Mid-State Technical College online dual credit registration form. Please complete the form below to register for your dual credit class(es).

You may want to have the following documents/information available before beginning the application process:

Social security number
High school name and anticipated graduation year

Legal Name

First Name

Middle Name

Last Name

Contact Information

Street Address:

City / Zip Code

My City / Zip Code is not on the list.

City:

Zip Code

this is a

CityTownshipVillage

E-Mail Address

County

in this state

Mobile Phone Number

May we text you?

YesNo

Other Demographics

Have you enrolled in a Mid-State dual credit class before?

YesNo

Social Security Number

Date of Birth (MM/DD/YYYY)

Gender

FemaleMaleNonbinaryDecline to State

The following questions relate to racial and ethnic identity. Please respond to both questions.

Ethnicity: Are you Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.

YesNo

Racial Identity: Select the racial group or groups that apply to you.

American Indian or Alaska Native AsianBlack or African AmericanNative Hawaiian or other Pacific Islander White

High School Attending

What grade are you currently in?

High School Graduation Year

Select highest degree earned by either parent

Have at least one parent in the Armed Forces on Active Duty:

Foster Care Youth (reside in foster care system):

Homeless Individual (lack fixed, regular or adequate night time residence.):

Economically Disadvantaged (Self-Reported)

Are you disabled?

Application Term

Class Registration

Select the class(es) you'd like to register for

Are you interested in more free credits?

Do you want to get a head start on a transferable program?

Constant Values

High School State

Mailing State

Are you a U.S. Veteran, Active Duty Armed Services member or current member of the National Guard or Reserves?

Displaced Homemaker

Highest Credential Received

Single Parent

Work Status

Registration Processed On