NOTE: When continuing to the next page of the form use the Next Button to continue to the next page or the Previous Button to return to a previous page. Do not use the browsers Forward > or Backward < buttons, you will receive an error message and will need to begin over.
Former / Maiden Name
Confirm Email Address
Tuition rates at Pennsylvania Highlands Community College are established by a student's residency. The College's Residency Policy can be found in the College Catalog.
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
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?
Social Security Number
Note: In order receive Financial Aid, you will need to provide your Social Security Number.
Country of Citizenship
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.
Race (Choose 1 or more)
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?
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
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
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
Please list in chronological order any colleges or technical schools that you have attended.
To add you information:
If your institution is not listed:
Repeat steps above to for each institution
State of Institution
Name of Institution
Program of Study/Major
Year of Graduation
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
How did you hear about Pennsylvania Highlands?
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.