Which school or organization recommended you for this experience? *

Student First Name *

Student Last Name *

Email Address *

• Minor Children Program Release Form - Requires Parent/Guardian Signature
• COVID-19 Waiver - Requires Parent/Guardian Signature

Minor Children Program Release Form *
Upload completed document

COVID-19 Waiver *
Upload completed document

Complete both documents and upload with your official transcript to unlock college course credit-awarding opportunities that count toward graduation: 2 credits for Midwest Learner Design Summit participation and/or 3 credits with Fall 2022 dual enrollment

• Dual Enrollment Nondegree Application - Requires Student Signature
• Dual Enrollment Form - Requires Student, Parent/Guardian, & Counselor Signatures

Which are you interested in? *
2 credits for Midwest Learner Design Summit participation
3 credits with Fall 2022 dual enrollment
None of the above (you don't need to complete the documents or upload your transcript)

Dual Enrollment Nondegree Application
Upload completed document

Dual Enrollment Form
Upload completed document

Official High School Transcript
Upload transcript

Your dual-enrollment acceptance letter, including credentials to access the network and Blackboard, will be sent to your mailing address. Those who register for 3 credits with Fall 2022 dual enrollment will participate in REP4 dual-enrollment orientation, including Blackboard tutorial, prior to the first day of class.

Complete the W-9 Form to receive your $500 stipend upon successful completion of the experience.

You don't need to complete the W-9 if you selected interest in "2 credits for Midwest Learner Design Summit participation" above. Your $500 will be released by the Office of Financial Aid and additional forms are not needed.

W-9 Form
Upload completed document