Student Application & Request for Accuplacer Testing
2020-21 Concurrent Enrollment & eCampus in the High School
Program Eligibility: Seniors 2.8 GPA; Juniors 3.2 GPA
Please only use black ink on this form
I am applying for: Concurrent Enrollment Only eCampus in the High School Only Both
Semester I want to enroll: Fall Spring Both Fall & Spring
First Name (legal): ________________________ First Name (preferred): ________________________
Middle: _______________________ Last Name: ____________________________________________
Address: ____________________________________________ City: ____________________________
State: ______ Zip Code: ___________ Phone Number (Required): ______________________________
Social Security Number (Optional): _______________ Gender Identity: Female Male Other
State of Residence: _____________________________ Number of Years in State: _________
Personal Email Address (Required): _______________________________________________________
This MUST be a personal email and not shared with anyone else. You must also be able to access this email at your high school.
Ethnicity (Optional): White Hispanic African American American Indian Asian Other
High School Name: _____________________________________________________________________
Graduation Year: ______________ GPA: ______
*If student has ACT scores, please supply high school transcript with ACT scores OR official ACT score report.
Student Signature______________________________________________________________________
High School Counselor Signature__________________________________________________________
RETURN THE COMPLETED FORM AND HIGH SCHOOL TRANSCRIPT TO:
Concurrent Enrollment Program: concurrent@minnesota.edu
eCampus in the High School: echs@minnesota.edu
Fax: 218.736.1573
Please plan for up to
5 business days for all applications to be processed.
