Application for High School Programs

This application is for high school students who want to participate in the College Credit Plus program while attending high school. If you want to attend Clark State after you graduate from high school, please complete the regular Clark State application.

Note: You should use a laptop or a desktop to complete step two of the application. You may not be able to enter your social security number on a phone or tablet.

If you have questions, please contact the Admissions Office at 937.328.6028.

All fields marked with an asterisk (*) are required.

First Name:

Please enter a valid First Name

Preferred or Nick Name:

Please enter a valid Preferred Name

Middle Name:

Please enter a valid Middle Name

Last Name:

Please enter a valid Last Name

Username:

Password: (Must be at least 7 characters long)

Confirm password:

Email:

Address:

Address line 1 Please use the following abbreviations if applicable: N,S, E, W, St, Ave, Rd, Dr

Address line 2 Do not enter more than 1 street address, use only if your address doesn't fit on line 1

*

City

*

State:

*

ZIP Code:

Phone number including area code(nnn-nnn-nnnn)

High School

*

High School Graduation Year:

Personal Detail:

*

Date of Birth: (mm/ddd/yyyy)

September 2017

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40 1 2 3 4 5 6 7

Clear

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OK

Cancel

NOTE: This is Step 1 of 2. After you click Submit, you must click on the link to complete Step 2.

The Clark State application will not be submitted until both steps have been completed.

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