myPEAK

College Application

Student Information

First Name

Middle Name

Last Name

Former / Maiden Name

Note: Please provide an email address that you will use to Receive Your Username, Activate Your Account, Change/Reset Your Password, and to use for Multi-Factor Authentication (MFA) on your college account.

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

Note: Please provide a mobile number that you will use to Activate Your Account, Change/Reset Your Password, and to use for Multi-Factor Authentication (MFA) on your college account.

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

Date of Birth

Social Security Number

Please Note: Social Security and Date of Birth is voluntary information; however, if you are applying as a degree-seeking student and intend on utilizing Financial Aid, both your Social Security Number and Date of Birth are necessary in order to process any aid awarded, inclusive of scholarships, grants, and loans.

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)

Additional Information

Are you currently a dislocated worker?

Is English your second language?

Are you currently a homeless individual?

Are you currently in, or have aged out of foster care?

Are you 18 or younger and have a parent that is active duty in the military?

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 (Note: You must make a selection for Admissions Status before proceeding to Location, etc.)

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 planning to transfer upon completion of your program at Penn Highlands, what colleges are you considering?

  - Option 1:

  - Option 2:

Student Athletics/Clubs

If you are interested in participating in a Penn Highlands athletics program or student club, please choose from the following options. Information on student clubs and organizations can be found online at: https://www.pennhighlands.edu/student-life/clubs-organizations/

Intercollegiate Varsity Athletics (NJCAA - National Junior College Athletic Association)

NJCAA Athletics: First Choice

NJCAA Athletics: Second Choice

Student Clubs and Organizations

Interests: First Choice

Interests: Second Choice

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

Proud Supporter Contact Information

Name of a Proud Supporter that we can contact on your behalf relating to your admissions, financial aid, and registration matters.

Proud Supporter Phone Number

Proud Supporter Email

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.

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