myPEAK

Student Information

First Name

Middle Name

Last Name

Former / Maiden Name

Email Address

Confirm Email Address

Address Information

Street

P.O. Box

City

State

Zip Code

County

Country

How long have you lived at this address?

If less than one year, enter prior county and state of residence:

Primary Phone Number

Cellular Phone Number

Work Phone Number

Demographic Information

The completion of the following information is voluntary and optional. It will be used to comply with Federal reporting and has no effect on admission to the College. Pennsylvania Highlands Community College is committed to the principle of equal education for all students without regard to race, national origin, marital status, creed, gender, age, or handicap.

Are you the first generation in your family to attend college?

Gender

Birth Date

Social Security Number

Note: In order receive Financial Aid, you will need to provide your Social Security Number.

Citizenship Information

Country of Citizenship

Citizenship Status

Note: If you are not a U.S. citizen or permanent resident, you will be required to submit a copy of your VISA to the Admissions Office.

Veteran Information

Veteran Status

Race Information

Ethnicity

Race (Choose 1 or more)

Educational Goals

Note: Non-Degree seeking students are not eligible to receive financial aid; and are permitted to enroll in a maximum of 11 credits (Part-Time status).

1. Admissions Status

2. Which Location do you plan to attend?

3. I plan to attend

4. Declared Major

Information regarding academic programs is available at http://elog.pennhighlands.edu 

  - If Liberal Arts and Sciences Major, select area of concentration:

     (Leave blank if none)

5. I plan to enroll in the following term

6. I plan to enroll in the following year

7. Reason for attending Pennsylvania Highlands Community College

8. What is your Career Goal?

9. If you are looking to transfer after earning a degree, what are your options for a transfer college?

  - Option 1:

  - Option 2:

High School Information

Name of High School

City

State

Zip Code

Graduation Information

Did you receive a High School Diploma?

Year of high school graduation

I have not received a High School Diploma because

GED Information - Complete if you did not graduate from High School

Have you earned a GED (General Education Diploma)?

Date GED Received

CTC/Vo-Tech School Information

Note: Please complete the following information if you attended a Career and Technical Center (CTC) or a Vo-Tech School.

Name of CTC/Vo-Tech School

City

State

Zip Code

Certificate Information

Did you receive a Certificate?

(IF YES) Year of CTC/Vo-Tech school completion

(IF NO) I have not received a Certificate because

College/Trade School Information

State of Institution

Name of Institution

Institution

City

Begin Date

End Date

Zip Code

Program of Study/Major

Year of Graduation

Degree Earned

Note: Save School Information before clicking on the "Next" button below

Emergency Contact Information

Name of Person to Contact in Case of an Emergency

Contact Phone Number

Completion

How did you hear about Pennsylvania Highlands?

Electronic Communication

The College may communicate with you in a variety of ways including email and text messaging. Please indicate below if you would like to opt out of receiving text and/or email messages from Pennsylvania Highlands Community College.

I wish to receive emails from Pennsylvania Highlands Community College.

I wish to receive text messages from Pennsylvania Highlands Community College.

Sign and Submit

By entering my name, I acknowledge that I have made application to Pennsylvania Highlands Community College and certify that the information provided on the application is true to the best of my knowledge.

Signature

Date