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Dual Enrollment

Semester Information
I. Enrollment Type
II. Personal Information

Student's Name

Street Address

III. Citizenship Information

Selective Service Information: All male citizens of the U.S. or Resident Aliens between the ages of 18 and 26 must have registered with Selective Service prior to registering for classes. This requirement does not apply to those exempt by federal law or veterans.

Are you a U.S. citizen?

IV. Ethnic Background

In addition, select one or more of the following
racial categories to describe yourself

V. High School Information

STUDENT: I certify that I am enrolled in high school and have completed the 10th or 11th grade. I understand that failure to apply and enroll at an eligible postsecondary institution will void the processing of this application to participate in the Dual Enrollment Grant program. I understand that the application shall be properly completed each semester in order to qualify. I understand that the grant shall be utilized for courses I complete that count towards hours of postsecondary credit. I also understand that if I withdraw from the eligible postsecondary institution I will be asked to pay the postsecondary institution for the courses, less any refund warranted by the postsecondary institution’s refund policy. 

Your Social Security Number will not be disclosed to individuals or agencies outside of the institution except in accordance with the institutional policy on student records.

Course Selection

Please select from the following Dual Enrollment Courses for the upcoming semester. Please note that by selecting a course from the list below, you are not officially registered for the course. Once your Dual Enrollment application has been processed, you will need to login to your MyDSCC account to officially register for your courses you have selected above/below.

If you plan to take more than 12 credit hours per semester, students must provide documentation of proper immunization for measles, mumps, and rubella (MMR) as well as Varicella (Chickenpox). You will not be able to register for all of your courses until this information is provided to the DSCC Office of Admissions and Records.

If you are enrolling in a lab science (i.e. General Biology or General Chemistry), you will also need to register for the lab that corresponds with the course lecture for a total of 4 credit hours.

       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
       CRN                     Course ID           Course Title
VI. Hepatitis B Agreement

The General Assembly of the State of Tennessee mandates that each public or private postsecondary institution in the state provide information concerning hepatitis B infection to all students matriculating for the first time. Tennessee law requires that such students complete and sign a waiver form provided by the institution that includes detailed information about the disease. The required information below includes the risk factors and dangers of the disease as well as information on the availability and effectiveness of the vaccine for persons who are at-risk for the disease. The information concerning this disease is from the Centers for Disease Control and the American College Health Association.

The law does not require that students receive vaccination for enrollment. Furthermore, the institution is not required by law to provide vaccination and/or reimbursement for the vaccine.

A. Hepatitis B (HBV)
Hepatitis B (HBV) is a serious viral infection of the liver that can lead to chronic liver disease, cirrhosis, liver cancer, liver failure, and even death. The disease is transmitted by blood and or body fluids and many people will have no symptoms when they develop the disease. The primary risk factors for Hepatitis B are sexual activity and injecting drug use. This disease is completely preventable. Hepatitis B vaccine is available to all age groups to prevent Hepatitis B viral infection. A series of three (3) doses of vaccine are required for optimal protection. Missed doses may still be sought to complete the series if only one or two have been acquired. The HBV vaccine has a record of safety and is believed to confer lifelong immunity in most cases.

VII. Signatures
VIII. Before You Submit

Before submitting, please take a moment to

  • make sure that you have selected all the correct courses in which you plan to enroll.
  • print a copy of this form. You will need this information to register.