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CONTINUING EDUCATION

Continuing Education Application

(For Part-Time Undergraduates)

PERSONAL DATA

First Name:
Middle Name:
Last Name:
Previous/Maiden Name:
Address:
City:
State:	Zip:
County:
Country (if other than U.S.):
Date of Birth:
Gender:	Female Male
Home Phone:
Work Phone:
Email Address:
Semester you wish to enter:
ACADEMIC PROGRAM INFORMATION Please indicate the program to which you are applying:
Associate Degree Programs Accounting Business Administration General Studies None selected
Bachelor Degree Programs Accounting Business Administration English (communications concentration) Health Care Management Individualized Major Psychology Sociology Other None selected
If Other:
Professional Certificates & Diplomas Accounting Business Management Communications and Public Relations Health Care Management Human Resources Liberal Studies Marketing Supervisory Management None selected
OPTIONAL INFORMATION (for reporting purposes only) Please check which best describes you: African American or Black Asian, Asian American, or Pacific Islander Latin, South, or Central American, or other Hispanic American Indian or Alaskan Native Caucasian (non-Hispanic) Other None selected
If other:
How did you learn about Lebanon Valley College? Newspaper Radio Direct mailing from the college LVC student or alumnus/a A relative or friend Other None selected
If Other:
HIGH SCHOOL INFORMATION
High School Name:
City:
State:
Graduation Date:
If you have less than 24 semester hours of transferable college credit, you must provide an official high school transcript or an official transcript of the GED examination scores to the Graduate Studies & Continuing Education Office, Lebanon Valley College, Annville, PA 17003.
UNDERGRADUATE AND GRADUATE COLLEGES Please indicate undergraduate and graduate colleges and universities attended including Lebanon Valley College (list most recent work first). Please have all official transcripts sent to our office.
Name of College:
Location (City/State):
Dates Attended (Month/Year - Month/Year):
Degree and Date Issued:

Name of College:
Location (City/State):
Dates Attended (Month/Year - Month/Year):
Degree and Date Issued:

Name of College:
Location (City/State):
Dates Attended (Month/Year - Month/Year):
Degree and Date Issued:
OTHER EDUCATIONAL EXPERIENCE (e.g. military, technical schools, business schools, correspondence schools, seminars, workshops, etc.)
Dates:
School or Program:
Location:
Credits or Certificates:

Dates:
School or Program:
Location:
Credits or Certificates:

Dates:
School or Program:
Location:
Credits or Certificates:
EMPLOYMENT
Employer:
Employer Address:
City:
State:	Zip:

UNDERSTANDING

By checking this box and submitting this on-line application, I hereby make application for admission and certify that all the information is complete and accurate to the best of my knowledge. I understand that all credentials submitted in support of this application become the property of the college and are not returnable. I have read all Lebanon Valley College policy statements relating to Continuing Education and agree to abide by them.

Please mail a check for the $30.00 non-refundable application fee to:

Graduate Studies & Continuing Education Office
Lebanon Valley College
101 N. College Avenue
Annville, PA 17003
717-867-6213
Toll free: 1-877-877-0423

Lebanon Valley College does not discriminate on the basis of race, national or ethnic origin, sex, age, religion, sexual preference or handicap.