Applicant's Current Legal Residence --
Street address*

P.O. Box:                                                           Apartment #:
   

City*                                                                   Zip*                      PA County*
         No Response01 Adams02 Allegheny03 Armstrong04 Beaver05 Bedford06 Berks07 Blair08 Bradford09 Bucks10 Butler11 Cambria12 Cameron13 Carbon14 Centre15 Chester16 Clarion17 Clearfield18 Clinton19 Columbia20 Crawford21 Cumberland22 Dauphin23 Delaware24 Elk25 Erie26 Fayette27 Forest28 Franklin29 Fulton30 Greene31 Huntingdon32 Indiana33 Jefferson34 Juniata35 Lackawanna36 Lancaster37 Lawrence38 Lebanon39 Lehigh40 Luzerne41 Lycoming42 McKean43 Mercer44 Mifflin45 Monroe46 Montgomery47 Montour48 Northampton49 Northumberland50 Perry51 Philadelphia52 Pike53 Potter54 Schuylkill55 Snyder56 Somerset57 Sullivan58 Susquehanna59 Tioga60 Union61 Venango62 Warren63 Washington64 Wayne65 Westmoreland66 Wyoming67 York

Email address:

Telephone number including area code*                     Cell phone number including area code
^{(i.e.: 7171234567 - no hypens or special characters)                                    (i.e.: 7171234567 - no hypens or special characters)}
                        

Are you a legal resident of Pennsylvania?*  No responseYes, more than a yearYes, less than a yearNo

Are you a United States citizen?*     Yes          No
                If NO, please indicate which country you are a citizen of:
               
                If you are not a US citizen, what is your citizenship status:
                SELECT ONEResident AlienNon-Resident Alien
                If you a non-resident alien, please indicate your Visa type:
                SELECT ONEJ-1F-1

If your name has changed, please provide it as it appears on other records:

Date of Birth*
Month: SELECT ONE01. January02. February03. March04. April05. May06. June07. July08. August09. September10. October11. November12. December   Day: selected SELECT ONE01020304050607080910111213141516171819202122232425262728293031   Year: SELECT ONE19991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911   

Sex*                  Parent's current marital status
SELECT ONEFemaleMale  SELECT ONE1 Married2 Single3 Separated4 Divorced5 Natural mother living, father deceased6 Living parent remarried7 Natural father living, mother deceased8 Other; explain in box below

Explanation for "other" in parent's marital status

Address of Parent or Legal Guardian 1           Address of Parent or Legal 2                 
            
City                 State        ZIP                   City                 State        ZIP
                   
Email Address                                           Email Address
           
Applicant lives (when not in school)                  Lives while attending TSCT*
SELECT ONE Parent 1 & Parent 2Parent 1 onlyParent 2 onlyLegal GuardianSpouseSelfOther            SELECT ONEWith Parent/GuardianOff campus in own homeOn campus in college owned building

If you are seeking college-level credit under the Perkins Statewide Articulation Agreement for a technical program at your high school or career and technology center, please submit the required documentation to the Registrar by July 1, 2012. The documents required are: a copy of your high school diploma, an official student transcript and the Secondary Competency List with the signature of a secondary school technical instructor.

Race:(Check all that apply)
 American Indian - A person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment)
 Asian - A person having origins in any of the original peoples of the Far East, Southeast Asian, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan. Korea, Malaysia, the Philippine Islands, Thailand, and Vietnam.)  
 Black or African American  
 Native Hawaiian or Other Pacific Islander  
 White

What are your goals for attending Thaddeus Stevens College? (Check all that apply)
Preparation for first job   Retraining for new career    Upgrading current skills to advance in field   Transferring to another college/university   Personal interest

Have you applied to other colleges?                         SELECT ONEYesNo
         If yes, is Thaddeus Stevens your first choice?  SELECT ONEYesNo
                  If no, which college is your first choice?