Dual Enrollment Student Questionnaire

Dual Enrollment Student Questionnaire

We're so excited you are interested in participating in the Dual Enrollment High School Partnership Program for the 2025 Summer Semester. This step takes about an hour to complete, so please make sure you have set aside enough time to get everything done. If you're a high school student, you may want to have a parent or guardian nearby so you can ask them questions. The Concurrent Enrollment Student Questionnaire has several parts, so please make sure you get all the way to the end.

Student Information

First Name*

Middle Name

Last Name*

What is your Date of Birth?*

This is the day, month, and year you were born.

Oh no!*

It looks like the date you provided as your date of birth indicates you are less than 10 years old. In order to participate in the Valley Now! High School Partnership Program you need to be in high school.

I'll fix it!

As of today, are you over 18 years old?*

Yes, as of today I am over 18 years old.

No, as of today I am not over 18 years old.

What is the name of your High School or Adult School?*

Select or enter value

What grade will you be in during the 2025 Spring semester?*

If you will be in the 9th grade, or a Freshmen, please select 9. If you will be in the 10th grade, or a Sophomore, please select 10. If you will be in the 11th grade, or a Junior, please select 11. If you will be in the 11th grade, or a Senior, please select 12.

Email Address*

Please make sure to list an email address that can receive messages and you check frequently. If there is a problem with the concurrent enrollment packet you submit below, we'll email you at this address.

PLEASE DO NOT PROVIDE ICLOUD EMAIL ADDRESSES (emails from our office don't get through).

PLEASE DO NOT LIST THE EMAIL ADDRESS PROVIDED BY YOUR HIGH SCHOOL OR ADULT SCHOOL.

Please provide your street address.*

For example: 123 Main St., Apt H2.

City*

Zip*

Student's Phone Number*

Phone

If you have and know your SBVC ID#, please provide it here

Since this questionnaire is the first step in the process, you may not have an SBVC ID# yet. If that's the case, just leave this question blank. However, if you have an SBVC ID# and know what it is, please list it in the box below. Please note: your SBVC ID# is different than your high school or adult school ID#. SBVC ID numbers are 7 digits long and do not have any letters.

Application Confirmation #/Application ID

If you have already completed your OpenCCC application to SBVC, you should have received an immediate email response under the subject line: "San Bernardino Valley College Application Submission Confirmation". This email contains an 8-digit number titled "Confirmation Number". You can also find this number on your OpenCCC dashboard. Here, it will be titled as "Application ID" near your application submissions.

Parent/Guardian Information

If you're under 18 years old, you must complete this section.

Parent/Guardian Information*

Students need to provide information for at least one Parent or Guardian. Please select what information you would like to provide:

Father/Guardian Information

Mother/Guardian Information

Both Father/Guardian and Mother/Guardian Information

Father's/Guardian's Name*

Father's Home Phone #*

Phone

Father's Work Phone #

Phone

Father's Cell Phone #

Phone

Mother's/Guardian's Name*

Mother's Home Phone #*

Phone

Mother's Work Phone #

Phone

Mother's Cell Phone #

Phone

Emergency Contact Name*

Please provide the name of someone we should contact in case of emergency.

Emergency Contact Relationship*

Emergency Contact Cell*

Phone

Concurrent Enrollment Course Information

For this section, please tell us which Valley Now! courses you'd like to take. Please note, in order to participate in the Dual Enrollment Program, you must take at least one course planned in partnership with your high school. Please also note that selecting a course below does not guarantee you will get a spot. Classes may fill before you register - so please make sure to keep an eye on your email and respond to correspondence from the Dual Enrollment team as soon as possible. If you're not interested in any of the courses planned through the Dual Enrollment High School Partnership Program, you need to contact the our Admissions department at admissions@valleycollege.edu for information and paperwork.

Please list the total number of SBVC courses you plan to take for the 2025SM semester.*

For the 2025SM Semester, most students can take up to 8 units in accordance with Education Code 76001 (d). In rare cases where students are only taking courses offered as part of a CCAP partnership, students may take up to 15 units in compliance with California Assembly Bill 288.

Please enter the first course you would like to take*

Please enter the second course you would like to take*

Please enter the third course you would like to take*

Signature Collection

In order to take concurrent enrollment courses at SBVC, your concurrent enrollment packet must be signed by you, a parent/guardian (if you are under 18), and your principal or their designee.

After you've applied to SBVC, the Valley Now! team will email a pdf copy of your concurrent enrollment packet to the email address you provided above. You will have to download the forms and sign as the student and, if needed, secure your parent/guardian's signature.

These signatures can be added using adobe or a third-party application like Kami. You also could print out the forms, sign them, and then scan them into pdf using a scanner or pdf scanning app. Once signed, you will have to upload the form to a questionnaire a lot like this one (we'll send you the link in the email with the forms).

Good job - but you're not done!

You're making great progress, but don't stop here! We can't prepare your concurrent enrollment forms to be signed unless you have created an OpenCCC.net account and submitted an online application to SBVC for the semester listed above! If you haven't done that, you should do that now! Once your online application to SBVC is complete and your Concurrent Enrollment Packet has been checked for errors, we'll send you your forms out for signing according to the method you chose above. You should receive an email from the Dual Enrollment Team within 2 weeks, so keep an eye on the email you provided above!

Send me a copy of my responses

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