IU South Bend High School Dual Credit Application

What is your legal sex? (* required)

Gender Identity

Mobile Phone Number

Home Phone Number

Please indicate your preferred contact number (* required)

Permission to Text? (* required)

Would you like to receive text messages about your application to Indiana University and other important information related to the admissions process? Additionally, if you choose to attend Indiana University, we will also send you text messages about upcoming deadlines and other important information related to your enrollment. Text and data rates may apply.

Permission to Text? (* required)

Would you like to receive text messages about your application to Indiana University and other important information related to the admissions process? Additionally, if you choose to attend Indiana University, we will also send you text messages about upcoming deadlines and other important information related to your enrollment. Text and data rates may apply.

No - do not send me text messages

Yes - Indiana University may text me concerning my application and admission

T-Shirt Size

Address

Home/Permanent Address (* required)

Country

Street

City

Region

Postal Code

How long have you lived at your home address? (* required)

List dates and address for the past two years (please include your Zip code, City and State): (* required)

Mailing Address (* required)

Same as Home/Permanent Address (* required)

Country

Street

City

Region

Postal Code

Citizenship and Ethnicity

Are you a United States citizen? (* required)

Yes

No

Citizenship 1 = United States [Hidden]

Country of Birth (* required)

What is your native language? (* required)

What is your country of citizenship? (* required)

What US immigration status/visa type do you now hold or intend to seek? (* required)

Are you Hispanic/Latino?

Yes

No

What is your ethnicity? Please select all that apply.

Are you a member or veteran of the United States Armed Service?

Yes

No

Have any of your parents/guardians or your spouse served in the United States Armed Forces, currently or in the past?

Neither

Parent/Guardian

Spouse

Parent/Guardian Information

Parent/Guardian First Name (* required)

Parent/Guardian Last Name (* required)

Relationship (* required)

Parent/Guardian Length at Address (* required)

Email (* required)

Parent/Guardian Address (* required)

Same as Home/Permanent Address (* required)

Country

Street

City

Region

Postal Code

Parent/Guardian Educational Experience

Have any of your parents or legal guardians completed a 4-year degree? (* required)

Did either or both of your parents attend college at an IU campus? (* required)

Enrollment Goals

When do you wish to enroll? (* required)

Educational History

Level of Study = High School [Hidden]

High School

High School Name (* required)

High School CEEB Code [Hidden]

School Address (* required)

Country

Street

City

Region

Postal Code

Graduation Date (* required)

Diploma Type (* required)

FERPA

FERPA, Federal Education Rights and Privacy Act (FERPA)

When a student reaches the age of 18 or begins attending a post-secondary institution, regardless of age, Federal Education Rights and privacy Act (FEPRA) rights transfer from the parent to the student.

By signing below, I give written consent for release of FERPA protected information from my educational record to the following persons for the following purposes:

(1) To Parent/legal guardian (listed below), to view my College Now/Pathways grades.

(2) To my Indiana University South Bend instructor and the IU South Bend Dual Credit Coordinator to contact my parent/legal guardian (named above) as it relates to my progress in this course.

(3) To Indiana University South Bend to release a roster including my final grade in any College Now/Pathways course(s) to the administrators at my high school, for their use in recording the grade on my high school transcript.

(4) To my Indiana University South Bend instructor to provide midterm grade reports to the IU South Bend Dual Credit Coordinator and/or my high school as needed for participation in extra-curricular activities.

Parent/Legal Guardian Name (* required)

Behavioral Disclosure

We are committed to maintaining a safe learning environment. As part of that commitment, Indiana University requires applicants to disclose if they

have been subject to formal disciplinary action (including for example, but not limited to, suspension or expulsion for academic or non-academic reasons at any high school, post-secondary institution, college or university;
have been charged with or convicted of a crime (or a foreign legal equivalent) that has not been expunged by a court; and/or have engaged in behavior that caused injury to person(s) or personal property (including for example, but not limited to, vandalism or behavior that led to a restraining order against you) which resulted in some form of discipline or intervention.

PLEASE NOTE: By submitting your application to Indiana University, you acknowledge and agree that you have a continuing obligation to inform the University of

any formal disciplinary action for academic or non-academic reasons at any educational institution;
any legal charges and/or convictions (or foreign legal equivalents) that have not been expunged by a court;
and/or any behavior that causes injury to person(s) or property which results in some form of discipline or intervention.

You must provide updated information to the campus admissions committee prior to class attendance. At that time, the campus admissions committee will review the information provided and may consider whether to delay or rescind your admission to IU.

Formal Disciplinary Action: Have you been subject to disciplinary action (including for example, but not limited to, suspension or expulsion) for a violent offense or sexual misconduct (including for example, but not limited to, physical violence; hazing; sexual harassment, violence, assault or exploitation; or similar offense) at any high school, post-secondary institution, college or university? (* required)

Yes

No

Charged or Convicted of Crime: Have you ever been charged or convicted of a crime (or a foreign legal equivalent) that has not been expunged by a court? Also select “Yes” if you have currently pending criminal charges (or a foreign legal equivalent) against you. (* required)

Yes

No

Acknowledgement

I certify that I am the applicant and that all statements on this application are correct and complete, including a list of all schools attended.

I understand that any of the items listed below constitute grounds for immediate withdrawal of my application from further consideration and cancellation of my admission and/or registration.

Withholding pertinent information requested on this application. Providing false or incomplete information. Failure to disclose disciplinary action or criminal activity, as outlined in the "Criminal Activity Disclosure" section of this application. I understand that providing false information could also impact the classification of tuition residency status for fee-paying purposes and scholarship eligibility.

Information Certification (* required)

I certify that all the information provided on this form is correct and complete

Textbook Certification (* required)

I understand that I am responsible for textbooks and/or e-text fees unless fees are paid by my school corporation. There are no free & reduced fee waivers.

Campus = IU South Bend [Hidden]

Application Source = Slate Sourced Application [Hidden]

Submitted Flag = Yes [Hidden]

Round Always Create = Yes [Hidden]

Round = IU South Bend [Hidden]

Admit Type = HSS [Hidden]

Generate PIN = Yes [Hidden]

IU South Bend Stage = Applicant [Hidden]

IU South Bend Applied Major = High School Student Enrollment [Hidden]

IU South Bend Admitted Major = High School Student Enrollment [Hidden]