ºìÐÓÖ±²¥app
Skip To Content
Skip To Menu
Skip To Footer
Search this site
ºìÐÓÖ±²¥app
Search this site
ºìÐÓÖ±²¥app
Academics
Life at Dickinson
Admissions
Tuition & Aid
Calendars
News & Events
Contact
ºìÐÓÖ±²¥app
Home
/
Home
Online forms
Adult Continuing Education
Adult Continuing Education
Application
First:
Required
Middle:
Required
Last:
Required
Gender:
Required
Female
Male
X - Another
Prefer not to say
Date of Birth:
Required
Citizenship:
Required
Yes
No
Other:
Required
Street:
Required
City:
Required
State:
Required
Zip Code:
Required
E-mail:
Required
Home Phone:
Required
Cell Phone:
Required
Employer:
Required
Employer Address & Phone:
Required
Plan to Attend:
Required
Fall
Spring
Summer
Year:
Required
Course(s) Interested:
Required
Course # and Title
Course 1:
Course 2:
1. Are you Hispanic/Latino?
Yes (including Spain)
No
2. Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you:
1 American Indian or Alaska Native (including all Original Peoples of the Americas)
2 Asian (including Indian subcontinent and Philippines)
3 Black or African American (including Africa and Caribbean)
4 Native Hawaiian or Other Pacific Islander (Original Peoples)
5 White (including Middle Eastern)
High School Name and Address:
Required
Graduation Date:
Required
College or University Name & Address:
Dates Attended:
Degree:
Do you plan on taking course for:
Required
Credit
Audit
Do you intend to apply for admission to ºìÐÓÖ±²¥app in the future?
Yes
No
If yes, have you met with a ºìÐÓÖ±²¥app admissions counselor?
Yes
No
Have you taken classes at ºìÐÓÖ±²¥app in the past?
Yes
No
If yes, what was your name at the time and what year did you attend?
Billing Address:
Current Address
Business Address
Other
Other (please specify):
I understand that taking continuing education classes at ºìÐÓÖ±²¥app in no way guarantees acceptance as a ºìÐÓÖ±²¥app degree-seeking student at any time now or in the future.
Student Signature:
Required
Signature:
Required