CCP Enrollment Application

By completing and submitting this application for CCP at the University of Mount Union, you are granting the institution to contact your high school for any additional information regarding your status.

APPLICANT INFORMATION

Will you be attending class:

At your high school

On Mount Union Campus

When do you plan in enrolling in College Credit Plus?

Social Security Number*

Statewide Student Identifier (SSID - see high school transcript) (N/A if homeschooled or attending a private school)*

First Name*

Middle Name

Last Name*

Mailing Address*

Country

Street

City

Region

Postal Code

Student Cell Phone

Home Phone

Birthdate

Gender

Male students who are at least 18 years of age and who are classified as an Ohio resident, must provide his Selective Service number to the college or university within 30 days of his 18^th birthday to be considered a College Credit Plus participant

Please enter your Selective Service Number (if you have reached 18 years of age and have registered for Selective Service)

Student Email Address (enter your personal email, not your school email)

Citizenship

Have you ever been charged or convicted for any felony or found to be delinquent in any state or country? (Note that you are not required to answer 'yes' to this question or provide an explanation, if the adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.)

Yes

No

Have you ever been charged or convicted for any behavior involving violence (e.g. murder, sexual assault) or harm to others (e.g. stalking, domestic violence, assaults, etc.) in any state or country? (Note that you are not required to answer 'yes' to this question or provide an explanation, if the adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.)

Yes

No

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in disciplinary action? These actions could include, but are limited to : probation, suspension, removal, dismissal, or expulsion from the institution.

Yes

No

Are you facing current disciplinary charges at any college, university or school?

Yes

No

PARENT OR GUARDIAN INFORMATION

Parent or Guardian 1

Parent Type

First Name

Last Name

Street Address

City

State

Zip

Home Phone

Cell Phone

Email

Parent or Guardian 2

Parent Type

First Name

Last Name

Home Phone

Cell Phone

Email

COURSE INTEREST

What year are you applying to start CCP class(s)?

What kind of courses are you interested in taking through CCP at the University of Mount Union or at your high school?

HIGH SCHOOL INFORMATION

High School*
(To narrow your search, please type in the city or 2-letter state abbreviation of the school location.)

High School CEEB

School Type

School Counselor

School Counselor Email

Guidance Office Phone

What year will you be graduating from high school?

By submitting this application, you certify that the above information is true and you are fully aware of the advantages and possible risks and consequences of participation in the College Credit Plus Program including potential financial responsibility.

Generate PIN

App: Submitted Flag

Yes

No

MATURE CONTENT QUESTIONNAIRE

Any student wishing to enroll in any college course under the College Credit Plus program must complete this questionnaire.

A student eligible to participate in College Credit Plus and admitted to a college/university will enroll in actual college courses, which may include "mature subject matter" as defined in Ohio Revised Code 3365.035.

Do you possess the necessary social and emotional maturity to participate in the College Credit Plus program?

Yes

No

Are you ready to accept the responsibility and independence that a college classroom demands?

Yes

No

Student Information - PLEASE TYPE OR PRINT:

Student Name:

Name of High School (or homeschooled):

*Student Signature:
Please type your legal name in place of your signature

Date:

*Although a signature by the student is not required by law, a college or university may wish to include it.

September 2021

Admission

CCP Enrollment Application