PHS Dual Credit Program Registration Form at PHS

PHS Dual Credit Program Registration Form
- Gender:
- Student Name
  
  First NameLast Name
- Please enter your name exactly as it appears on your government- issued ID.
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Personal Education Number (PEN)
- Current Grade Level
- Cumulative high school GPA
- Current School
- School Location
- Parent's Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- What Courses are you interested in taking?
- Intake/ Enrolment Period
- Government-Issued Photo ID or Passport
  
  Cancelof
- Academic Transcripts
  
  Cancelof
- I acknowledge that my information will be used to assess eligibility and that the required student information will be shared with UCR for program administration, subject to applicable privacy requirements.
Should be Empty: