University of Michigan-Flint
Application for Dual Enrollment
Last updated: 2-12-18
List the most recent high school(s) attended. Ocial transcripts are to be forwarded to the UM-Flint Admissions Oce by your guidance counselor.
High School City, State Attended from Attended to
(mm/yy) (mm/yy) Graduation Year For oce use only
The University of Michigan-Flint offers four pathways through which students may pursue college level coursework while completing high school:
Dual Enrollment Educational Partnerships (DEEP): DEEP programs are cohort-style dual enrollment programs that range from 6-14 credit hours over an academic year. These
programs are created in collaboration with a number of partnering school systems. Students must be enrolled at one of these partnering schools in order to participate in a DEEP program.
A complete list of DEEP programs and schools can be found at
Early College: Early Colleges are an intensive three year high school program that combines the best elements of the high school and early university experience. Students must work
with their high school counselor to apply for this program.
Which of the dual enrollment types are you pursuing? m DEEP m Early College
Oce of Admissions • 303 E. Kearsley St. • 245 University Pavilion • Flint, MI 48502-1950 • (810) 762-3300 • Fax: (810) 762-3272 • um
Last Name (Legal) First Name (Legal) Sux Middle (Full)
Previous last name(s), if any Birth date (mm/dd/yy) Social Security Number Gender
m Female m Male
Current Mailing Address (Number and Street) City State Zip Code
Permanent Mailing Address (if dierent) City State Zip Code
Mobile Phone Home Phone Email Address
Citizenship Native Language
m U.S. Citizen m Permanent Resident/Green Card m Noncitizen Country
Race/Ethnicity: Information is collected for state and federal reporting requirements, as well as for statistical purposes.
It is not used in the admission process and will have no bearing on your admission status.
Please indicate whether you consider yourself to be Hispanic or Latino.
m No, not Hispanic or Latino m Yes, Hispanic or Latino
In addition, select one or more of the following racial categories to describe yourself:
m American Indian or Alaska Native m Asian m Black or African American m Native Hawaiian or Other Pacic Islander m White
Parent Email Address
Parent Mobile Phone
Dual Enrollment Educational Partnerships (DEEP):
Which Location?
Which Semesters (check all that apply)?
m September - Fall 2019 m January - Winter 2020
Which Program?
Have you ever been expelled, suspended, or placed on probation by any secondary school or college
you attended for academic dishonesty or because of an oense that harmed or had the potential to harm others?
m Yes m No
Have you ever been convicted of a criminal oense other than a minor trac violation, or been found
to be delinquent by a juvenile court, or are there such charges currently pending against you at this time? m Yes m No
If you answered yes to either of the questions above, you must include a separate, detailed statement of explanation.
By my signature, I certify that the answers I have given to all questions on this application are correct and complete to the best of my knowledge. I understand that falsication or omission
of information or credentials may result in revocation of admission. I understand that I am responsible for following the University of Michigan-Flint’s registration policies. If I fail to
comply with the University’s policies, I understand that I will be responsible for any charges that are incurred. Additionally, I understand my signature below authorizes the University of
Michigan-Flint to release my academic information including, but not limited to grades, transcripts, enrollment, and attendance records to my current school or third party agencies, school
district administrator(s), and intermediate school district (ISD) administrator(s) each term during my attendance as a student.
Student Signature (required) Date
My son/daughter has my approval to enroll as a dual enrolled student at the University of Michigan-Flint. I understand that I am responsible for payment of charges incurred by my child that
are not covered by the school district for all dual enrollment terms.
Parent Signature (required) Date
PAYMENT AUTHORIZATION (To be completed by public school ocials.)
The school district identied below commits to provide nancial support pursuant to state regulations in support of dual enrollment.
Name of High School
High School Ocial Signature Title Date
Any balance not covered by the high school is the student’s/parent’s responsibility
Are you a Michigan resident? m Yes, since (month/year): m No
If you have lived outside the state of Michigan in the last three years, please list the most recent state (or nation if outside the US) and approximate dates you lived there.
If any of the following circumstances listed below apply, you are required to le an Application for In-State Tuition if you wish to be considered for in-state tuition assessment.
You live outside the State of Michigan for any purpose.
• You attended or graduated from a college outside the State of Michigan.
• You lived or worked outside the State of Michigan at any time within the last three years.
• You are not a U.S. citizen.
• Your spouse, partner, or parent is in Michigan as a nonresident student, medical resident, fellow or for military assignment or other temporary employment.
• You are 24 years of age or younger and a parent lives outside the State of Michigan.
• You are 24 years of age or younger and attended or graduated from a high school outside the state of Michigan.
• You attended or graduated from an out -of -state high school and have been involved in educational pursuits for the majority of time since high school graduation.
• You attended any University of Michigan campus (Ann Arbor, Dearborn, or Flint) as a nonresident.
Questions pertaining to your residency status can be answered by sta in the Residency Classication Oce, University of Michigan Oce of the Registrar, 1210 LSA Building, 500 South
State Street, Ann Arbor, MI 48109-1382, phone (734) 764-1400. To apply for in-state tuition classication visit
Payment Authorization Waved
Signed DEEP Agreement With High School