Continuing Education Application

Lebanon Valley College admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the college. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other college-administered programs.


PERSONAL DATA
*First Name: 
Middle Initial: 
*Last Name: 
Previous/Maiden Name:
*Address: 
*City: 
*State:  *Zip: 
County:
Country (if other than U.S.):
*Date of Birth: 
*Gender: 

Citizenship Status:

Country of Citizenship: (if not United States)

Select one or more races:





Are you Hispanic/Latino:

*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

Bachelor Degree Programs





If Other:

Professional Certificates & Diplomas




MORE INFORMATION

Please check which best describes you:





If Other:

How did you learn about Lebanon Valley College?





HIGH SCHOLL 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 atteneded 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.