Home
Apply
Apply for High School Programs
Request Information
Web
Site
Search
Tuesday, April 20, 2021
..::
Apply for High School Programs
::..
Register
Login
Step 1 of 2 - Create an Account
This application is for high school students who want to participate in the College Credit Plus or Tech Prep program while attending high school. If you want to attend Clark State after you graduate from high school,
click here.
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:
<Select>
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
ZIP Code:
Phone number including area code(nnn-nnn-nnnn)
High School
*
High School
Graduation Year:
<Select>
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
Personal Detail:
*
Date of Birth: (mm/ddd/yyyy)
April 2021
Sun
Mon
Tue
Wed
Thu
Fri
Sat
13
28
29
30
31
1
2
3
14
4
5
6
7
8
9
10
15
11
12
13
14
15
16
17
16
18
19
20
21
22
23
24
17
25
26
27
28
29
30
1
18
2
3
4
5
6
7
8
Clear
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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.
Clear form
Copyright 2016-2020 Clark State Community College
Terms Of Use
Privacy Statement
);