Undergraduate Application

UNDERGRADUATE APPLICATION

One College Green, PO Box 50, La Plume, PA 18440-0200 570-945-8111 or 877-4COLLEGE [email protected] Fax: 570-945-7916 www.keystone.edu Checklist: q 1. Complete application (applications may also be submitted online or through the Common App). q 2. Send official high school transcript or GED. q 3. Send official college transcript if you have earned college credits. q 3. Optional: Send SAT or ACT scores (Keystone’s school code is SAT-2351 and ACT 3602). If received, test scores will be considered. Admissions may request test scores in some cases. q 4. A letter of recommendation, teacher evaluation, or a personal statement about why you should be considered for admission to Keystone are not required, but highly recommended.

If you previously attended another college/university: q 1. Contact Registrar’s Office of all previous institutions for official transcripts to be sent to Keystone College, Admissions Office. If you earned fewer than 12 college credits, it is necessary to also submit an official high school transcript. q 2. Transfer students intending to pursue a bachelor’s degree in education with teaching certification and having earned a minimum of 36 credits at their previous institution must submit the official results of passing Praxis I/PECT. q 3. If you previously attended Keystone College as a matriculating student, full-time or part-time, you may not need to complete the application. Please contact the Admissions Office to be formally readmitted.

Financial Aid q 1. File the Free Application for Federal Student Aid (FAFSA). The FAFSA can be filed online at www.fafsa.ed.gov. The Keystone College code for financial aid is 003280.

Complete the following information. Please print clearly. I. PERSONAL INFORMATION/DEMOGRAPHICS

Last Name First Middle Former Last Name (if any) Preferred First Name

Address City State Zip County

Country Telephone Cell Phone* e-mail *Required: Would you like to receive text alerts and messages from Keystone College pertaining to Admissions? q Yes q No

Social Security Number Birth Date: Month/Day/Year Country of Birth To receive federal or state financial aid or loans you must provide your social security number. Gender q Male q Female Country of Citizenship Alien Reg. # (if U.S. permanent resident) q Identify as

Is English Your Primary Language? q Yes q No TOEFL date (if taken) q Prefer not to answer Are you Hispanic/Latino? q Yes, Hispanic or Latino (including Spain) q No Please describe your background

Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you: q American Indian or Alaska Native (including all Original q Black or African American (including Africa Peoples of the Americas) Are you enrolled? q Yes q No and Caribbean) If yes, please enter Tribal Enrollment Number ______q Native Hawaiian or Other Pacific Islander (Original q Asian (including Indian subcontinent and Peoples) Philippines) q White (including Middle Eastern) q Race and ethnicity unknown q Two or more races II. APPLICATION INFORMATION

I am applying for admission as: q Full-Time (12 credits or more) q Part-Time (less than 12 credits) q Online - Bachelor’s in Business or Accounting If Weekender, please check location: q La Plume q Towanda

I will be applying as a: q First-Year Student q Transfer

I am applying for: q Spring q Summer q Fall q year I will be: q Living on-campus q Commuting Full-time students who are under 21 years of age and live outside a 50 mile radius of the College are required to live on campus for their first year. Housing deposits must be received by May 1, 2017 to guarantee on campus housing.

If you have previously attended Keystone College, please list your dates of attendance:

III. EDUCATIONAL INFORMATION High School Information:

High School Attended (Name, City, State, Zip Code) Date of Graduation

Transfer Information

College Attended (Name, City, State, Zip Code) Dates Attended Number of Credits or Degree Earned

Describe any special circumstances that the admissions office should be aware: (optional, attach additional information if necessary)

GED Score (if applicable)

IV. PLEASE LIST ANY EXTRA-CURRICULAR, COMMUNITY, OR VOLUNTEER ACTIVITIES:

Are you interested in participating in athletics? q Yes q No If YES, please circle which sport(s) below.

basketball baseball softball soccer field hockey golf (M,F) (M) (F) (M,F) (F) (M)

cross country tennis indoor/outdoor track volleyball lacrosse wrestling (M,F) (M,F) (M,F) (F) (M,F) (M)

Are you interested in participating in band or choral activities? q Yes q No V. FINANCIAL AID INFORMATION

Do you plan to apply for Financial Aid? q Yes q No

Are you or have you ever been a member of the U.S. Armed Forces? q Yes q No If yes, dates of service

Does your employer or your parents’ employer(s) offer tuition assistance? q Yes q No

Will you receive tuition assistance from OVR, WIA & NAFTA (TAA)? q Yes q No

Have you ever been found responsible for a disciplinary violation at any secondary school you have attended, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal or expulsion from the institution? q Yes q No

Have you ever been convicted of a misdemeanor, felony, or other crime? q Yes q No If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident and explains the circumstances.

VI. FAMILY INFORMATION

Name of Mother Name of Father Name of Guardian (if other than parent)

Address (if different) Address (if different) Relationship

City, State, Zip City, State, Zip Address (if different)

Telephone Number Telephone Number City, State, Zip

Employer Employer Telephone Number

Occupation Occupation Employer Occupation

College(s) Attended Degree College(s) Attended Degree College(s) Attended Degree

Preferred Parent e-mail

Please list any relative or close friend who attends/attended Keystone College:

Name Relationship

Who or what most influenced your decision to apply to Keystone College? q Guidance Counselor q Keystone Athletic Coach q Teacher q High School Athletic Coach q Internet q Alumnus/Alumna q College Guide Book q Advertising (where) q Keystone College Representative (who) VII. INTENDED MAJOR (You must select one of the following intended areas of study)

School of Arts & Sciences School of Professional Studies n Allied Health q Environmental Studies q Accounting q Medical Technology q Forensic Biology q Accounting Principles (online) q Nursing/Cytotechnology (Natural Science) q Business B.S. A.S. q Occupational Therapy q Geology q Business Administration (online) q Radiography/Medical q Industrial-Organizational B.S. A.S. Imaging/Cardiac Perfusion Psychology (online) n Education q Art (AFA) q Liberal Studies q Early Childhood B.S. A.S. q Biology (Natural Science) q Microbiology q Early Childhood/Special Ed q Communications n Pre-Medical Tracks q Middle Level Language Arts B.S. A.S. q Pre-Chiropractic q Middle Level Social Studies q Communication Arts q Pre-Med q Teaching: Art Ed (K-12) q Criminal Justice q Pre-Pharmacy q Teaching: Child & Family Studies B.S. A.S. q Pre-Physical Therapy q Teaching: Math Ed (7-12) q Criminal Justice/Psychology (Natural Science) q Teaching: Social Studies (7-12) (double major) q Pre-Physicians Assistant n Education: Accelerated q Environmental Biology q Pre-Veterinarian Certifications (for those already q Environmental Resource q Psychology possessing a Bachelor’s Degree) Management q Public Health q Early Childhood q Environmental Resource q Social Science q Early Childhood/Special Ed Management: Petroleum q Visual Arts q Teaching: Art Ed (K-12) and Alternative Energy q Wildlife Biology q Teaching: Math Ed (K-12) concentration B.S. A.S. q Teaching: Social Studies (7–12) q Hospitality Business Management q Information Technology B.S. A.S. THANK YOU for taking the first step in pursuing q Sport and Recreation Management an educational experience with Keystone College.

I understand that all Keystone literature is intended for informational purposes, is subject to change and therefore does not constitute a contract between the College and its students.

I authorize Keystone College to publish for public relations purposes any photographs in which I may appear.

I hereby apply for admission to Keystone College and agree to abide by its regulations. I certify that the information given on this form is complete and accurate.

I understand that I may be subject to disciplinary action, including admission revocation or expulsion, should the information I have certified be false.

Signature of Applicant Date

Signature of Parent or Guardian (if applicant under 18 years) Date

Keystone College Anti-Discrimination and Harassment Policy Keystone College is a leading, comprehensive, student-centered college educating students in the liberal arts and sciences tradition. The College does not discriminate on the basis of race, color, religion, national origin, ancestry, disability, sex, sexual orientation or age. This policy is consistent with Title IX of the Education Amendments of 1972. For the full policy, please visit www.keystone.edu/title-ix. Keystone College admits qualified students without regard to race, color, national origin, sex, age, religion, ancestry, handicap, union membership or any other legally protected classification