Application for Admission to
Continuing Studies Programs
Main Campus

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:
Employer:

* MAJORS

Bachelor's of Arts Degree Programs

Behavioral Health Studies

Advanced Professional Studies

Corporate Communications

Human Resource Management

Psychology & Organizational Behavior

Bachelor of Arts Degree Completion

Business

Liberal Arts

Bachelor's of Science Degree Programs

Business Accounting & Finance

Business Administration

Business Marketing & Planning

Computer Systems Management

Nursing Completion Program RN to BSN

Associate of Science Degree

Business

Computer Information Systems

Credit Certificate Programs

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

WHERE HAVE YOU HEARD ABOUT ALVERNIA COLLEGE?

Alumni	Co-Worker	College Fair	Friend	Web Site
Mailings	Newspaper	Radio	Television	Other

FEDERAL AND STATE REGULATIONS REQUIRE THAT THE FOLLOWING INFORMATION BE COLLECTED; THEREFORE, IT IS REQUESTED THAT THE APPROPRIATE ENTRY BE MARKED.

Citizenship: U.S. Other Sex: Male Female Military Veteran: Yes No

Ethnic Origin: American Indian /          Alaskan Native Asian / Pacific       Islander Black, Non-Hispanic Hispanic White / Caucasian Unknown / Other

Marital Status: Single Married Divorced Separated Widowed

Religion: Roman      Catholic Jewish Protestant Other Unknown

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.