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Student Information
First Name
Preferred Name
Middle Initial
Last Name
Birthdate
Birthdate
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
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25
26
27
28
29
30
31
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
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1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Email Address
Country of Citizenship
Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas Da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius, and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos Islands (Keeling Islands)
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Coral Sea Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Federated States of Micronesia
Fiji
Finland
Foreign/Unknown
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia, Republic of North
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau, the Pacific Islands of
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Svalbard and Jan Mayen
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Contact Information
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Mobile Phone Number
May we communicate with you via your mobile phone (text messaging, mobile calls, etc.)?
May we communicate with you via your mobile phone (text messaging, mobile calls, etc.)?
Yes
No
Enrollment Information
I will be a
First Year
Non-Degree
Transfer
International First Year
International Transfer
Second Degree
Graduate Studies
International Graduate Studies
Graduate Readmit
Graduate Non-degree
Readmit
Early College
Anticipated Start Term
Fall 2020
Fall 2021
Fall 2022
Fall 2023
Fall 2024
Fall 2025
Fall 2026
Fall 2027
Fall 2028
Fall 2029
Fall 2030
Fall 2031
Fall 2032
Fall 2033
Fall 2034
Fall 2035
Spring 2022
Spring 2023
Spring 2024
Spring 2025
Spring 2026
Spring 2027
Spring 2028
Spring 2029
Spring 2030
Spring 2031
Spring 2032
Spring 2033
Spring 2034
Spring 2035
Summer 2022
Summer 2023
Summer 2024
Summer 2025
Summer 2026
Summer 2027
Summer 2028
Summer 2029
Summer 2030
Summer 2031
Summer 2032
Summer 2033
Summer 2034
Summer 2035
Winter 2022
Winter 2023
Winter 2024
Winter 2025
Winter 2026
Winter 2027
Winter 2028
Winter 2029
Winter 2030
Winter 2031
Winter 2032
Winter 2033
Winter 2034
Winter 2035
What degree will you be pursuing?
Associate Degree
Bachelor Degree
Second Degree
Undergraduate Certificate
Master Degree
Doctoral Certificate
Doctorate Degree
Graduate Certificate
Graduate Non-Degree
What Associate degree do you want to study? Please choose one.
Criminal Justice (Associate's)
Environmental Technology AAS
Exploratory Studies (Undecided)
Healthcare Professions AAS - Credentials Study Option
Healthcare Professions AAS - Non-Credentials Study Option
Nursing ASN
Nursing ASN - LPN License Holders Study Option
Radiologic Technology AAS
What Bachelors degree do you want to study? Please choose one.
Accounting
American Sign Language and English Interpreting
Anthropology
Applied Computer Science - Data Science
Applied Computer Science - Mobile and Game Application Development
Applied Computer Science - Web Development
Audiology and Speech-Language Pathology
Audiology and Speech-Language Pathology 2+2 Study Option
Biology - Cellular Biology and Molecular Genomics
Biology - Ecology and Environmental Conservation
Biology - Fisheries
Biology - Marine Biology
Biology - Natural History BA
Biology BA
Biology BS
Biomedical Sciences - General
Biomedical Sciences - Medical Genomics and Counseling
Biomedical Sciences - Medical Laboratory Science
Biomedical Sciences - Pre-Medical Sciences
Biomedical Sciences - Pre-Pharmacy
Biomedical Sciences - Pre-Physical Therapy
Biomedical Sciences - Pre-Physician Assistant
Business Administration - Finance
Business Administration - Information Technology & Analytics
Business Administration - Management
Business Administration - Marketing
Business Administration - Personal Financial Planning
Chemistry - Biochemistry (ACS, ASBMB)
Chemistry - Forensics (ACS)
Chemistry - Natural Products (ACS)
Chemistry - Pre-Medicine (ASBMB)
Chemistry BA
Chemistry BS
Communication Studies - Interpersonal Communication
Communication Studies - Leadership and Public Advocacy
Communication Studies - Organizational Communication
Computer Science
Criminal Justice
Criminal Justice - Conservation Law Enforcement
Digital Forensics and Cybersecurity
Early Childhood Education Grades PreK-4
Early Childhood Education Grades PreK-4 - Education of the Deaf and Hard of Hearing
Economics - Business
Economics - General
Economics - Political
Electronics Engineering Technology
Electronics Engineering Technology 2+2 Study Option
Engineering Physics
Engineering Physics 2+2 Study Option
Engineering Physics 3+2 Study Option
English - Creative Writing
English - Literature and Culture
English - Professional Writing
Environmental, Geographical and Geological Sciences - Environmental Geoscience
Environmental, Geographical and Geological Sciences - Geography and Environmental Planning
Environmental, Geographical and Geological Sciences - GIS and Spatial Analysis
Environmental, Geographical and Geological Sciences - Professional Geology
Exercise Science
Exercise Science - Pre-Athletic Training
Exercise Science - Pre-Chiropractic
Exercise Science - Pre-Occupational Therapy
Exercise Science - Pre-Physical Therapy
Exploratory Studies (Undecided)
Health and Physical Education BSED
Health Science - Applied Health Studies
Health Science - Pre-Athletic Training
Health Science - Pre-Athletic Training 3+2 Study Option
Health Science - Pre-Occupational Therapy
Health Science - Pre-Physical Therapy
Health Science - Pre-Physical Therapy 3+3
Health Science - Pre-Physicians Assistant
Health Science - Pre-Physicians Assistant 3+2
Health Science - Pre-Professional
Health Science - Public Health Education
History
International Business - Accounting
International Business - Economics
International Business - Finance
International Business - Human Resource Management
International Business - Information Technology and Analytics
International Business - Marketing
International Business - Policy and Globalization
International Business - Supply Chain Management
Languages and Cultures - Arabic Studies
Languages and Cultures - Chinese Studies
Languages and Cultures - French Studies
Languages and Cultures - Russian and Eastern European Studies
Languages and Cultures - Spanish
Languages and Cultures - Spanish Translation and Interpretation
Mathematics
Mathematics - Applied Mathematics
Media and Journalism - Emergent Media
Media and Journalism - Journalism
Media and Journalism - Media Production
Media and Journalism - Public Relations/Strategic Communications
Medical Imaging
Middle Level Education - English/Language Arts (4-8)
Middle Level Education - Mathematics (4-8)
Middle Level Education - Science (4-8)
Middle Level Education - Social Studies (4-8)
Multidisciplinary Studies BA
Music - Elective Studies in Business BM
Music - Performance Instrumental BM
Music - Performance Vocal BM
Music - Technology BM
Music BA
Music Education - Instrumental
Music Education - Vocal
Nursing BSN
Nursing BSN - RN to BSN
Nutrition - Dietetics
Nutrition - Sports Nutrition
Political Science
Political Science - International Affairs
Political Science - Pre Law
Political Science - U.S. Public Administration
Professional Sales and Marketing
Psychology
Radiation and Health Physics
Respiratory Care
Respiratory Care 2+2 Study Option
Secondary Education - Biology
Secondary Education - Business Education
Secondary Education - Chemistry
Secondary Education - Earth and Space Science
Secondary Education - English
Secondary Education - General Science
Secondary Education - Mathematics
Secondary Education - Physics
Secondary Education - Social Studies
Social Work
Sociology
Special Education
Special Education PK-12 and Early Childhood Education PK-4 Dual Certification
Sport Management
Supply Chain Management
Technical Leadership
Theatre - Design/Technology
Theatre - Integrated Theatre
Theatre - Performance
Visual Arts BA - Art History
Visual Arts BA - Ceramics
Visual Arts BA - Digital Media
Visual Arts BA - Drawing
Visual Arts BA - Fabric Design
Visual Arts BA - Graphic Design
Visual Arts BA - Painting
Visual Arts BA - Photography
Visual Arts BA - Printmaking
Visual Arts BA - Sculpture
Visual Arts BFA - 2D Media
Visual Arts BFA - 3D Media
Visual Arts BFA - Art History
Visual Arts BFA - Drawing
Visual Arts BFA - Fabric Design
Visual Arts BFA - Graphic Design
Visual Arts BFA - Painting
Visual Arts BFA - Photography
Visual Arts BFA - Printmaking
Visual Arts BFA - Sculpture
What Certificate program do you want to study? Please choose one.
Child Life Specialist Certificate
Digital Forensics Certificate
Early Childhood Curriculum and Assessment for Early Care and Education Certificate
Early Childhood Development, Education and Family Certificate
English as a Second Language Certificate
Media and Journalism - Emergent Media Certificate
Museum Conservation Certificate
Playwork Certificate
Pre-Medical Sciences Studies Certificate
Pre-Physician Associate/Assistant Studies Certificate
What Masters degree do you want to study? Please choose one.
Accountancy (MAcc)
Applied Exercise Physiology: Non-thesis Study Option (MS)
Applied Exercise Physiology: Thesis Study Option (MS)
Athletic Training (MS)
Biology (MS)
Business Administration (MBA): Accounting
Business Administration (MBA): Analytics
Business Administration (MBA): Business Administration
Business Administration (MBA): Healthcare Management
Business Administration (MBA): Leadership and Human Resources
Business Administration (MBA): Marketing
Business Administration (MBA): Strategic Global Decisions
Business Education (MEd)
Business Education: Student Teaching in BCIT Study Option (MEd)
Business Education: Teacher Internship in BCIT (MEd)
Clinical Mental Health Counseling: Children and Adolescents Study Option (MS)
Clinical Mental Health Counseling: General Mental Health Counseling Study Option (MS)
Clinical Mental Health Counseling: Military Veterans and their Families Study Option (MS)
Curriculum & Instruction (MEd)
Educational Leadership: PK-12 Principal Certification (MEd)
Educational Leadership: PK-12 Supervisor of Curriculum & Instruction Certification (MEd)
Information Technology (MS)
Instructional Design and Technology: Instructional Technology Specialist Study Option (MS)
Instructional Design and Technology: Learning Experience Designer Study Option (MS)
Nursing: Family/Individual Across the Lifespan (MSN)
Nursing: Nurse Administration (MSN)
Nursing: Nurse Practitioner - Primary Care Adult Gerontology (MSN)
Nursing: Nursing Informatics (MSN)
Nursing: Public Health (MSN)
Nursing: Public Health - School Health (MSN)
Physician Assistant (MHS)
Reading (MEd)
School Counseling (MS)
Social Work (MSW)
Social Work (MSW): Advanced Standing Study Option
Special Education (MS)
Special Education: PK-12: Advanced Certification Study Option (MEd)
Special Education: PK-12: Initial Certification Study Option (MEd)
Special Education: PK-12: Intern Certification Study Option (MEd)
Speech-Language Pathology (MS)
Sport & Performance Psychology (MS)
Sport Management (MS)
Sport Management: International Sport Management (MS)
What Doctorate degree do you want to study? Please choose one.
Audiology (AuD)
Nursing (DNP): Advanced Practice
Nursing (DNP): Nurse Anesthesia
Nursing (DNP): Nurse Executive
What Graduate Certificate do you want to study? Please choose one.
Foundations of Trauma Informed Care Certificate
Instructional Design and Technology: e-Learning Specialist (Certificate)
Instructional Design and Technology: Instructional Game Design (Certificate)
Intraoperative Neurophysiological Monitoring (IONM) Certificate
Military Resilience & Trauma Counseling Certificate
Post Baccalaureate Teacher Education - English as a Second Language Certificate
TeleMental Health Certificate
Trauma Informed Counseling Certificate
What Doctoral Certificate do you want to study? Please choose one.
Foundations of Trauma Informed Care Certificate
Instructional Design and Technology: e-Learning Specialist (Certificate)
Instructional Design and Technology: Instructional Game Design (Certificate)
Intraoperative Neurophysiological Monitoring (IONM) Certificate
Military Resilience & Trauma Counseling Certificate
Post Baccalaureate Teacher Education - English as a Second Language Certificate
TeleMental Health Certificate
Trauma Informed Counseling Certificate
What do you want to study? Please choose one.
Grad Non-Degree
This selection is available at Bloomsburg.
This selection is available at Lock Haven.
This selection is available at Mansfield.
This selection is available at Clearfield.
Which campus(es) are you interested in?
Which campus(es) are you interested in?
Bloomsburg
Lock Haven
Mansfield
Clearfield
Additional Information
I would like to provide more information about: (select all that apply)
I would like to provide more information about: (select all that apply)
My Current School
Parent/Supporter Information
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School Information
Current high school or most recent college (Please select your school from the list provided).
HIDDEN: School CEEB Code
School Type
High School
Undergraduate
Graduate
High School Graduation (Month/Year)
High School Graduation (Month/Year)
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February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Parent/Supporter Information
Parent/Supporter First Name
Parent/Supporter Last Name
Parent/Supporter Email Address
Parent/Supporter Phone Number
Relationship Type
Father
Legal Guardian
Mother
Step-Father
Step-Mother
Questions
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Do you have any questions for Admissions?
Yes
No
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