Jenison Dual Enrollment Form

The maroon and gold Central Michigan University action C logo.

This form is only to be used for students attending Jenison Public Schools.

The form must include your high school counselor/principal signature and should be submitted at least three weeks before your course start date. A new registration form must be submitted each semester that you dual enroll.

First name *

Last name *

Email *

Date of Birth *

Which Jenison Public School do you attend? *

Jenison High School
Jenison Innovation Academy
U-Tech Preparatory Academy

Grade level *

Freshman (9)
Sophomore (10)
Junior (11)
Senior (12)

Central Michigan University recognizes that a secure environment enhances learning opportunities. To provide the best possible learning environment, we require applicants to respond to the following statements, as part of the admissions process:

For reasons involving academic dishonesty, financial impropriety, or an offense that harmed or had potential to harm others, has any secondary school or college you have attended taken any of the following actions against you: expulsion, suspension, placed on a probationary period, other disciplinary action, or entered into an informal resolution resulting in disciplinary action with you? *

Have you ever been convicted of a criminal offense other than a minor traffic violation, or are there criminal charges pending against you at this time? *

Select term: *

Course Title (Ex: PSY 100) *

Section Number (Ex: 22344638) *

Select term:

Course Title (Ex: PSY 100)

Section Number (Ex: 22344638)

Select term:

Course Title (Ex: PSY 100)

Section Number (Ex: 22344638)

ALTERNATIVE SCHEDULE
*optional - if courses above are unavailable

Select term:

Course Title (Ex: PSY 100)

Section Number (Ex: 22344638)

TUITION

It is the responsibility of the student to ensure this information is accurate and that their dual enrollment tuition is paid in full. If you drop/withdraw from a course, you may also be responsible for paying your school district back for their contribution.

Select a choice *

Pays ALL tuition
Pays ZERO tuition
Other... This choice will expand a text box

If "other" selected, how much will the school pay per course?

COURSE DROP OR WITHDRAW
*must be submitted prior to drop/withdrawal deadline

Select term:

Course Title (Ex: PSY 100)

Section Number (Ex: 22344638)

I certify all the information on this form is correct, and I agree to have information regarding my CMU dual enrollment (e.g., course schedule, final grade, etc.) shared with my high school.

Student Electronic Signature *

*A copy of the submitted form will be emailed to you

Date (MM/DD/YY) *

THIS SECTION MUST BE COMPLETED BY HIGH SCHOOL COUNSELOR OR PRINCIPAL

Counselor/Principal Email Address *

*A copy of the submitted form will be emailed to you

Counselor/Principal Electronic Signature *

*I certify that this student is in good academic standing and has our district’s approval to enroll in the above dual enrollment course(s) through CMU. I have confirmed that the tuition paid by the school district is accurate.

Date (MM/DD/YY) *

Who should be contacted for questions regarding dual enrollment billing?

*Please provide name, email, & phone number

Will the school be paying for the cost of books/supplies (beyond the tuition contribution listed above)? *

Yes
No
Other... This choice will expand a text box

How many class periods are taught at the district per day? *

5 classes per day
6 classes per day
7 classes per day
Other... This choice will expand a text box

If you have any questions, please feel free to email us at onlineprograms@cmich.edu or call us at 989-774-4371.