Dual Credit Application

If you are NOT a dual credit student, please go back and choose the Panola College Candidate application.

1109 West Panola Carthage, Texas 75633

903.693.2038

www.panola.edu

Name Information

First Name

Middle Name

Last Name

Suffix

What is your preferred first name?

Other names or aliases which may appear on academic records (Maiden/Birth Name): 

Gender

Birth Date

Social Security Number

Citizenship Information

Birth Country

Citizen Status

Visa Status

Race Information

Race (Choose one or more)

Ethnicity

Military Information

Are you a veteran?

(if requesting benefits, you must submit a military transcript)

Are you a veteran's spouse or dependent?

Contact Information

Do you reside outside of the United States?

Address Line 1

Address Line 2

Zip Code

City

State

County

If Panola County, have you lived here for the last 12 months?

Country

Is your Mailing Address different from your Permanent Address?

Mailing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone Number

Do you agree to receive text messages from college faculty or staff regarding your student account?  

Email Address

Confirm Email Address

Texas Residency

Are you a resident of Texas?

If not Texas Resident, which state?

Did you live in Texas for the 36 months leading up to your high school graduation or Texas GED certification?

When you begin your semester at PC, will you have lived in Texas for 12 months?

Were you enrolled in a Texas Public college or university during the previous 12 months?

If yes, were you classified as a Texas resident at that college or university?

Is the parent or legal guardian upon whom you base your claim of residency a U.S. citizen?

What country is your parent a resident of?

If not, does the parent or legal guardian upon whom you base your claim of residency hold Permanent Resident Status (valid I-551) for the U.S.?

Is this parent or legal guardian a foreign national whose application for Permanent Resident Status has been preliminarily reviewed?

Is this parent or legal guardian a foreign national here with a visa eligible to domicile in the United States or are you a Refugee, Asylee, Parolee, or here under Temporary Protective Status?

If so, indicate which:

Does this parent or legal guardian currently live in Texas?

If your parent or legal guardian currently lives in Texas: How long has he or she been living here?

What is your parent's or legal guardian's main purpose for being in the state?

If your parent or legal guardian is a member of the U.S. military, is Texas his or her Home or Record?

Candidacy Information

The first question on this page allows the user to choose the year and then dynamically populates the term based on the response to the first question. The second question's data source has a place holder called ##CandidacyYear that is associated with the year question on the Options tab. Defining ## placeholders in data sources requires that another question on the form be associated with that placeholder to be used as an input in the data source at the time it is executed. 

At what location do you plan on studying?

Indicate on what basis you are seeking admission:

What year do you plan to begin your studies?

What term do you plan to begin your studies?

What type of student will you be?

Choose a program of study.

Choose a program of study.

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact email address:

What is the relationship to your emergency contact?

School Information

Please indicate your current status

GED Test Date

State of GED Program

What was (or is your expected) date of high school graduation?

Please list the high schools you graduated/will graduate from.

**Give the school list a few seconds to load after you select the state

If you do not see your school in the list, please select School Not Listed and type in the name of the school.

After the state and school are selected, click 'Add to List'.

State of High School/Institution

Name of High School/Institution

School is required.  Please make sure you add to list above and yours appears below

Have you previously attended any other colleges or universities?

I understand that I must furnish a current, official transcript from EACH college and/or high school attended to the Admissions Office at Panola College. High school transcripts* must have a date of graduation included.

*An official high school transcript must include date of graduation (after graduation has occurred), be signed and stamped/embossed by a school official, and arrive in the Registrar's Office in a sealed envelope from the issuing school.

I have taken the TSI assessment in the last 5 years?

Did you take a tech prep course or courses for college credit?

Please list all colleges that you have attended.

You are required to list all colleges you've attended (if any). 

If you do not see your school in the list, please select School Not Listed and type in the name of the school.

***Please give the list of schools a few seconds to load after you choose your state.

After the state and school are selected, click 'Add to list'.

State of College/University

College/University

Name of College/University

What degree earned, if any?

List of Schools

Are you a first generation college student?

Please indicate the highest level completed of your parents' or legal guardians' educational background.

Parent/Guardian 1

Parent/Guardian 2

For the following questions, click "Yes" if they apply to you.

Are you an individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground?

Are you in, or have you aged out of, the foster care system?

Is your parent currently on military active duty?

Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian?

Are you either unmarried or divorced with custody of a child under the age of 18 (including if you are currently pregnant)?

Do you have limited English Speaking ability because English is not your native language? 

Do you have a disability that may make you eligible for support services or funding under the Perkins Career and Technical Education Grant?

Have you been gainfully employed full-time in Texas for the past 12 months?

Have you received primary support form a social service agency for the past 12 months?

How did you find out about Panola College?

Acknowledgement 

I certify that the information provided is accurate to the best of my knowledge. I understand this information will be used by the officials of Panola College in creating state reports and determining residency. I also understand that signing this application confirms that I am familiar with the information provided about Bacterial Meningitis.

I certify that the information in this application for admission is true and correct and that misrepresentation or omission of information will be cause for dismissal or denial of admission. If accepted as a Panola College student, I agree to abide by the rules and regulations of Panola College regarding conduct and all other obligations. I also authorize Panola College to electronically access test scores (TSI or alternates/GED) from any institution or corporate entity which is associated with the transmission of the requested information. I hereby knowingly, freely, and voluntarily waive any right or cause of action arising as a result of the transmission of this information from which any liability may or could accrue to these stated organizations. I understand that Panola College will upon request, provide me with a copy of any of the above documents and I further understand that I have the right to challenge the accuracy of those records.

Digital Signature