CharlesCountyDualEnrollmentForm

College of Southern Maryland

Charles County Public School Dual Enrollment Form

This form is intended for students who want to take classes through CSM directly.
Student Information

Please provide the required information below.
Student Name*

First NameMiddle NameLast Name
Student Date of Birth*

MonthDayYear
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Phone Number*

Area CodePhone Number
Student E-mail*
Please provide your personal, non-High School email address
High School Information

Please provide the required information below.
Student's Charles County High School*
Lackey HS Counselor HS*
La Plata HS Counselor*
McDonough HS Counselor*
North Point HS Counselor*
St. Charles HS Counselor*
Thomas Stone HS Counselor*
Westlake HS Counselor*
Student CCPS ID#*
Student's Anticipated HS Graduation Date*

MonthDayYear
High School Grade*
Junior, Senior, etc.
Current Cumulative Unweighted GPA*
Out of 4.00
Semester/Year Participating in the Dual Enrollment Program*
Please indicate if student is eligible for Free and Reduced meals. Students who are eligible will have tuition waived. (Status will be verified by High School Counselor)

YesNo
Please check if this student is eligible for Free and Reduced meals. Students who are eligible will have tuition waived. (Status will be verified by High School Counselor)*

Yes, student is eligible.No, student is not eligible.
What CSM courses are you interested in taking?
Please use the upload feature below to upload a recent copy of your high school transcript. If you are supplementing your transcript with SAT or ACT scores, you can upload a copy of your SAT/ACT score report here as well.

You are able to complete and submit this application without uploading these files, but you will be required to submit these documents to your Enrollment Coordinator before your application can be processed.
Upload PDF file of your High School transcript, SAT/ACT scores

Browse Files
Your HS transcript can be accessed through your HS account. SAT/ACT scores can be accessed through their respective accounts. Cancelof
Program Requirements

Please review and accept the below requirements.
Student Signature*
Parent/Guardian Signature*
High School Counselor Signature

Clear
High School Principal Signature

Clear
Counselor Notes/Course Suggestions
Should be Empty:

College of Southern Maryland

Student Information

High School Information

Program Requirements