Dual Enrollment Parent/Guardian Permission Form
Applicant Name: ____________________________ High School: ____________________Grad Year_______
Parent/Guardian Name ______________________________________________________
Relationship to Student _____________________________________________________
Address______________________________________________________________________________
City__________________________________________St_______________Zip___________________
Phone ___________________________________Email__________________________________
The above student has my permission to pursue dual enrollment study at Messiah College. I certify that I am
his/her legal guardian/parent. I am also familiar with the standards and expectations for student conduct at
Messiah College as summarized in the College Catalog and/or expressed in the Community Covenant. I
realize that the student listed above, if admitted, must abide by these guidelines. I also certify that the
information I have provided on this application is complete and accurate.
Parent/Guardian Signature______________________________________Date______________________
Please indicate below if you are a Messiah College Employee
(YES)/(NO) I am an employee of Messiah College and I have reviewed the Employee Handbook regarding
tuition benefits.
Submit Completed Form to [email protected] or mail completed form to
Admissions (attn. Dual Enrollment)
Messiah College
One College Avenue, Suite 3005
Mechanicsburg, PA 17055