UNIVERSITY OF PITTSBURGH AT TITUSVILLE
APPLICATION FOR NON-DEGREE AND GUEST STUDENTS (VISITING STUDENTS)
NO APPLICATION FEE REQUIRED HIGH SCHOOL AND/OR PREVIOUS COLLEGE TRANSCRIPTS NOT REQUIRED
Name
ID Number Date of Birth Social Security # ______________________
Address
Phone (home) (work) E-mail address:
|
Ethnicity - Please Circle One: (see notes below) |
|||||
| Prefer Not to Answer (9) | Black Non-Hispanic (1) | American Indian or Alaskan Native (3) | Asian or Pacific Islander (2) | Hispanic (4) | White Non-Hispanic (5) |
|
Citizenship - Please Circle One: |
|||
| U.S. Citizen (US) | Non-Immigrant Student Visitor (FS) | Refugee in U.S. (RF) | U.S. Immigrant Permanent Resident (FP) |
Employer
Name of High School
City & State of High School
Year of graduation from high school Did not graduate
Did you ever attend any campus of the University Pittsburgh?
No
If yes">
UNIVERSITY OF PITTSBURGH AT TITUSVILLE
APPLICATION
FOR NON-DEGREE AND GUEST STUDENTS
(VISITING STUDENTS)
NO
APPLICATION FEE REQUIRED HIGH
SCHOOL AND/OR PREVIOUS COLLEGE
TRANSCRIPTS NOT REQUIRED Name
ID Number Date
of Birth
Social Security # ______________________ Address
Phone
(home)
(work) E-mail address:
Ethnicity - Please
Circle One: (see notes below)
Citizenship - Please Circle One: Employer Name
of High School City
& State of High School
Year of graduation from high school
Did not graduate Did
you ever attend any campus of the University
Pittsburgh?
No
If yes, which campus?
when? Previous
College Did you graduate? Yes No Previous
College
Did you graduate? Yes No
Please
list any additional colleges on the back of
this form. Term
applying for: Fall
Spring
Summer Signature:
Date:
Completed form must be turned in to the
Office of the Registrar, Bennett Davis Hall
Room 112, phone 814-827-4482 or
sent by Fax to 814-827-5405.
Notes: U.S. Citizen=a person
owing allegiance to the United States of
America; Non-Immigrant Student Visitor=all
aliens who have residence in a foreign country
which they have no intention of abandoning and
whose stay in the United States is limited to
a defined period of time and a definite
purpose that, by its nature, may be promptly
accomplished; Refugee in the U.S.=all
aliens who have fled or been rejected from
their country of nationality for reasons of
race, religion, political opinion, or war;
U.S. Immigrant Permanent Resident=one who
intends to make the U.S. his permanent
residence and who is in possession of a
permanent immigration visa by the Department
of Justice.
Prefer Not to Answer (9)
Black Non-Hispanic (1)
American Indian or
Alaskan Native (3)
Asian or Pacific Islander
(2)
Hispanic (4)
White Non-Hispanic (5)
U.S. Citizen (US)
Non-Immigrant Student
Visitor (FS)
Refugee in U.S. (RF)
U.S. Immigrant Permanent
Resident (FP)