Adult Student Information Request Form

There are many types of applications for admission, please complete the request form thoroughly so that we may send the appropriate application and related information.

PERSONAL INFORMATION:

First Name:

Mid Init:

Last Name:

Maiden Name:

Home Address:

City: State:  Zip Code:

Country:

Phone:

Gender: Male Female

Date of Birth (DD/MM/YYYY):

Email Address:

Expected Date of Entry: 2011 2012


HIGH SCHOOL AND GED INFORMATION:

Did you graduate from High School?

► If YES, indicate name of high school:

► If NO, indicate last high school attended:
What year did you obtain the GED?
What was your actual or approximate total GED score?


STANDARDIZED TEST INFORMATION:

Did you take the SAT or ACT exam in high school (Please note that this is not a requirement for adult student admission.)?
Yes, SAT Yes, ACT No


MILITARY INFORMATION:

If you are or have been in the Armed Forces, please answer the following questions:

Are you a:
Veteran Reservist Other:

Do you have education benefits from the GI Bill?
Yes No Uncertain

Comments:


POST HIGH SCHOOL EDUCATION:

Have you attended  post-secondary institutions? Check all that apply.

No

Yes, I attend or have attended the following training institution(s):
Please note that some training institutions are licensed to give associate degrees, however, they are not regionally accredited and the course work may not be viewed by Penn State as "transfer" credits.

Yes, I attend or have attended the following college(s) or university(ies):

Institution:
Name of Program:
Approximate GPA/grades:

Institution:
Name of Program:
Approximate GPA/grades:

Institution:
Name of Program:
Approximate GPA/grades:

Institution:
Name of Program:
Approximate GPA/grades:


FINANCIAL AID:

Have you submitted the Free Application for Federal Student Aid (FAFSA) application?
Yes No

If you are currently employed, does your employer offer tuition reimbursement?
Yes No Uncertain


MISCELLANEOUS:

When are you available to take classes, please check all that apply
Daytime Evenings Saturdays
Click here to view the degrees that can be completed by attending evenings only.

I am unable to relocate from the local area and therefore am interested in the degrees available at Penn State Behrend only.

I am able/willing to relocate to another Penn State location.


The following information can be accessed from our Web site:
Click here for -
Free Application for Federal Student Aid
The six digit federal code for Penn State is 003329.
Financial Aid Information for Adult Students

Please check if you would like the following sent to you:
Paper Application for Adult Student Admission
Computer related degrees at Penn State Behrend
Other: Information on the following majors:


Intended Field of Study 1: 

Intended Field of Study 2: 

Intended Field of Study 3: 

Comments:



Penn State Erie, The Behrend College • 4701 College Drive, Erie, PA 16563 • 814-898-6000 • Toll-free: 866-374-3378
© 2014 The Pennsylvania State University • Web site contact: bdwebmaster@psu.edu
HomeSite MapAccessibilityHotlinesPrivacy & Legal StatementsCopyright

Web site contact: bdwebmaster@psu.edu
Updated July 18, 2005
© 2005 The Pennsylvania State University