PUPS | Student Information - Continuing Education Programs

Create a password:
Minimum of 8 Characters

Student's First Name:

Student's Last Name:

Student's Middle Initial:

Student's Preferred Name:

Student's Date of Birth
(MM/DD/YYYY):

Student's Gender:

Student's T-Shirt Size

(Adult Sizes):

Student's Current School:

Student's Grade:

Student's Graduation Year:

Student's Current GPA:

Student's Cumulative GPA:

Is the student a DukeTip Scholar?

if Yes, enter ID

Is the student a SC - Junior Scholar?

if Yes, enter Year

Special Accommodations:

Special Accommodations Description:

Mailing Address:

City:

State:

Zip Code:

Phone Number:

Student's Email Address:
Note: This email address will be used to sign into the student's account. Please make sure to record this information.

DukeTIP	Junior Scholar	Direct Mailing	Teacher/Guidance Counselor
Internet Search	USC Website	Trade Show/ Conference	Newspaper Ad
Friend/Relative	Continuing Education Course Catalog		Other

Salutation
Last Name:
First Name:
Relationship:
Home Phone:
Daytime Phone:
Mobile Phone:
Parent/Guardian Email:
Please enter address information if different from student
Address:
City:
State:
Zip Code:
Does the student live with this person?

Salutation
Last Name:
First Name:
Relationship:
Home Phone:
Daytime Phone:
Mobile Phone:
Parent/Guardian Email:
Please enter address information if different from student
Address:
City:
State:
Zip Code:
Does the student live with this person?
Are your parents/guardians USC Alumni Association Members?	If so, please provide their USC Alumni Association Member ID:
Security Check

Continuing Education Programs