Alvernia College

Application for Admission to
the Continuing Studies Program at Alvernia College

ADMISSION PROCEDURE

1. Complete this form.
2. Submit the signature card (you will see the signature card after you Submit this application) with $25 non-refundable application fee made payable to Alvernia College.
3. Submit official copies of high school transcripts and/or GED scores.
4. Submit a copy of DD214 from military (if applicable).

PERSONAL DATA
Social Security #:
Date of Birth:
   
  Miss Ms. Mr. Mrs.
First Name:
Middle Name:
Last Name:
Maiden Name:
   
Street Address:
 
City:
State:
Zip: -
County:
   
Home Phone:
Work Phone:
E-Mail:

LOCATION

Main Campus Other Off-site


Please select one of the following programs that you are applying for:
Note: Not all majors are offered at all of the locations.
Bachelor of Arts Degree Programs
Advanced Professional Studies
Behavioral Health Studies
Corporate Communications
Criminal Justice
Elementary Education
Special Education
Human Resource Management
Psychology & Organizational Development
Degree Completion-Business or Liberal Studies
Bachelor of Science Degree Programs
Business Accounting & Finance
Business Administration
Computer Systems Management
RN-BSN Completion Program

RN-BSN Completion Program with School Nurse Certification
Associate of Science Degree Programs
Business
Computer Information Systems
Liberal Studies
Cerificate
Behavioral Health Studies
Human Resource Management

INDICATE ENROLLMENT TERM: MOD

ENROLLMENT STATUS

Have you previously applied for admission to Alvernia College?

Yes semester/year
No

EDUCATIONAL HISTORY

College/Institution
(List All Attended) 		Location
(City/State)
Dates Attended
(Include Month/Year)
Degree Earned Credits Completed
to
to
to
to
to

PROFESSIONAL EXPERIENCE
Employer (Name/Address)
Dates
Position
to
to
to

WHERE HAVE YOU HEARD ABOUT ALVERNIA COLLEGE?
Mailings Radio       (station) College Fair
Television (station) Newspaper (name) Friend
Web-Site Alumni Co-Worker
Other

Citizenship:
U.S.
Other
 

If not a United States citizen: Are you legally authorized to attend an institution of higher education in the United States?
Yes
No

If no, please complete the Supplemental Information Sheet for International Applicants available in the Graduate Center.


FEDERAL AND STATE REGULATIONS REQUIRE THAT THE FOLLOWING INFORMATION BE COLLECTED; THEREFORE, IT IS REQUESTED THAT THE APPROPRIATE ENTRY BE MARKED.
Sex:
Male
Female
Military Veteran:
Yes
No
   
Ethnic Origin:
American Indian /
         Alaskan Native
Asian / Pacific Islander
Black, Non-Hispanic
Hispanic
White / Caucasian
Other
   
Marital Status:
Single
Married
Divorced
Separated
Widowed
   
Religion:
Roman Catholic
Jewish
Protestant
Unknown
Other

Upon submission of this application you will see a signature page for verification purposes.
Please print and mail in the page with a non-refundable $25.00 application fee.
This fee must be submitted in order to be considered for acceptance.
Make check payable to Alvernia College.

Please submit signature card to the location to which you are applying to.

Alvernia College complies with all federal, state, and local non-discrimination laws in the administration of its educational programs and services and in its employment relationships.


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