Dual Enrollment Application

Thank you for your interest in taking a Dual Enrollment course at Westfield State University!

To get started, please fill out the application completely. Once submitted, the program coordinator will reach out for additional information, and to update you on the progress of your application.

If you have any questions during the process, don’t hesitate to reach out—we’re here to help!

Student Information

First Name

Preferred Name

Middle Name or Middle Initial

Last Name

Birthdate

Legal Sex

Home Address

Country

Street

City

Region

Postal Code

Email Address

Home Phone

Mobile Phone

May we text you at this number?

Yes

No

Parent/Guardian Contact Information

First Name

Last Name

Home Address

Country

Street

City

Region

Postal Code

Mobile Phone

Email Address

High School Information

School Name

School CEEB Code

Expected year of graduation

Current grade while taking this course(s)

Freshman

Sophomore

Junior

Senior

SASID #

(Student SASID # is available at the Guidance Office or your High School Transcript. SASID's are 10 digits. If homeschooled, please enter HOMESCHOOL)

School Counselor Contact Information

Counselor First Name

Counselor Last Name

Counselor Email

Are you part of a Westfield Promise pathway?

Yes

No

Course Selection

Please choose the below term you would like to take a dual enrollment course in:

Summer II 2026

Fall 2026

First Choice - Example: ECON 0101 / 501 / (11090) / Online or MW 1:40-3:55/ CR: 3.0

Please fill in your course selection information below. Please select your first, second, and third choice classes. If you need to view the list of classes available, please click the link below:

Summer II Class Offerings
Fall Class Offerings

Course Subject and Number

Section #

CRN (5 digits)

Day(s) and Time

# of Credits

Second Choice - Example: ECON 0101 / 501 / (11090) / Online or MW 1:40-3:55/ CR: 3.0

Course Subject and Number

Section #

CRN (5 digits)

Day(s) and Time

# of Credits

Third Choice - Example: ECON 0101 / 501 / (11090) / Online or MW 1:40-3:55/ CR: 3.0

Course Subject and Number

Section #

CRN (5 digits)

Day(s) and Time

# of Credits

Demographic Information

Please answer the following questions for data reporting purposes and to assist us in providing equitable access to CDEP grant funds. For the first question, please go to the Massachusetts Department of Elementary and Secondary Education webpage to learn more.

Are you participating in the following programs? Please select all that apply:

A "first-generation college student" is defined as a student whose parent(s) / legal guardian(s) have not completed a four-year college bachelor's degree. The definition also applies to a student who regularly resided with and received support from only one parent/guardian, and whose only such parent/guardian did not complete a bachelor's or 4-year college degree in the U.S.

Based on the above definition, are you a first-generation college student?

Yes

No

Do you speak a language(s) other than English at home?

Yes

No

If yes, which language(s) do you speak?

Are you interested in Science, Technology, Engineering, or Math (STEM disciplines)?

Yes

No

Hispanic or Latino

Yes

No

Ethnic/Racial Background (Choose all that apply)

High School Transcript

Please submit your high school transcript.

Student Type Information

Interactions = Westfield Dual Enrollment

Student Signature

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Parent/Guardian Signature

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