ApplyDE - Account & Registration Request

Student First Name*

Student Last Name*

Student Middle Name or Initial

Suffix

Preferred Name

High School

Vocational Center

Are you a US Citizen?*

Select Citizenship Type

Social Security Number*

Estimated High School Graduation Month / Year*

Email*

Please use a personal email address so you can receive communication from Dual Enrollment Administrators. Many high school email accounts do not accept mail from outside of your high school.

Confirm Email*

Password*

Please choose a strong password, with min. 8 characters, at least 1 digit and 1 uppercase letter

Retype Password*

Have you lived in Louisiana for the last 365 days?*

Home Address*

City*

State*

Zip Code*

Date of Birth*

Gender*

Primary Phone Number (10-digit)*

10 digits (i.e. 5551231234)

Cell Phone Number (10-digit)

10 digits (i.e. 5551231234)

By checking box, I opt-in to receive text message notifications. Standard message and data rates apply.

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent Email

Parent Phone Number (10-digit)

10 digits (i.e. 5551231234)

What is the highest level of education that your Parent/Guardian completed?

Are you of Hispanic or Latino descent?

Regardless of your answer above, please select one or more race(s) that you identify with:

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

White

Louisiana Law (R.S.17.170) requires all students to either (1) provide proof of immunization for measles, mumps, rubella, diphtheria, tetanus, and meningitis, according to the guidelines of the Louisiana Health Department; or (2) sign a waiver indicating they refuse immunizations.

Immunization Choice*

Emergency Contact Information

Full Name*

Same as Parent/Guardian

Relationship to Applicant*

Emergency Contact Phone Number (10-digit)*

10 digits (i.e. 5551231234)

I understand that admission to the College does not constitute admission to every program offered by the college. I understand that different programs carry different admissions criteria. I further understand that it is my responsibility to have all required admissions documents turned in on or before the specified deadline.
I understand that if I am currently on probation/suspension from any higher education institution, the credits completed at this institution while on probation/suspension may not transfer back to the institution.
I do hereby authorize the Institutions access to the following records to fulfill my admission requirements:

My academic records
My immunization records from Louisiana Immunization Networks (LINKS)
My Selective Services registration

In compliance with the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), instituions may, with student consent, release personally identifiable information contained within student education records to state agencies for the purposes of identifying programs and resources that may benefit the student. I authorize the Institutions to disclose the following information, to the extent the college possesses such information or variations thereof, about me to other State of Louisiana agencies for the purposes of identifying resources and benefits for which I may qualify that could assist me with the direct and/or indirect costs of attending college: First Name, Last Name, Date of Birth, and Social Security Number.

I certify that all information on this application is true to the best of my knowledge. I understand that providing false information on this application may result in the inactivation of my application or expulsion from this institution. By submitting this application, I am certifying that I agree to abide by all policies of this institution.

I agree to the above terms*

Your portal to dual enrollment in Louisiana

Emergency Contact Information