Student Registration for Pre-College Program Get a jump start on your college career Gain confidence Build relationships with faculty and Alvernia students Explore majors and areas of interest Enjoy campus amenities Student InformationStudent First NameStudent Middle NameStudent Last NameStudent Mailing AddressStudent Mailing AddressCountryStreetCityRegionPostal CodeStudent PhoneStudent Email AddressHigh SchoolGraduation YearThe following information is required either by federal agencies or for identification purposes:Social Security NumberStudent BirthdateStudent BirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900GenderGenderFemaleMaleCitizenshipAfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius, and SabaBosnia and HerzegovinaBotswanaBouvet 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IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.Macedonia, Republic of NorthMadagascarMalawiMalaysiaMaldivesMaliMaltaMan, Isle ofMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalau, the Pacific Islands ofPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSpratly IslandsSri LankaSudanSurinameSvalbardSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweReligionAnglicanAssembly of GodBaptistBrethrenBuddhistCatholicChristianChurch of GodEastern OrthodoxEpiscopalianGreek OrthodoxHinduHolinessIslamJehovahs WitnessJewishLutheranMennoniteMoravianMormonNazareneNoneOtherPentacostalPresbyterianProtestantQuaker FriendsRussian OrthodoxSeventh Day AdventistSikhismUkranian OrthodoxUnitarianUnited Church of ChristUnited MethodistWesleyanEthnicityEthnicityAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanicMulti-RacialNative Hawaiian or Other PacificUnknownWhiteAcademic InterestAccountingAddictions and Mental Health TreatmentAddictions and Mental Health Treatment + MA in Clinical Counseling (MACC)Athletic TrainingBiochemistryBiologyBiology Medical Laboratory ScienceBusiness Administration and ManagementChemistryCommunicationComputer ScienceCreativityCriminal JusticeCyber SecurityData ScienceDigital Media MarketingEarly Childhood (PK-4) & Special Education (PK-12)Early Childhood Education (PreK-4)EconomicsEngineeringEnvironmental ScienceExercise ScienceExploratoryFinanceForensic ScienceGeneral ScienceHealthcare AdministrationHealthcare ScienceHealthcare Science (Associates Degree)HistoryHuman Resource ManagementLiberal StudiesLiteratureMarketingMathematicsNursingOccupational TherapyPhilosophyPhysical Therapy (BS/DPT 3+3 Program)Physician Associate (BS/PA 3+2 Program)Political SciencePre-DentalPre-LawPre-MedicalPre-OptometryPre-PharmacyPre-VeterinaryPsychologyPsychology + MA in Clinical Counseling (MACC)Social WorkSport ManagementTheatreTheologyParent/Guardian InformationParent/Guardian First NameParent/Guardian Last NameParent/Guardian EmailParent/Guardian BirthdateParent/Guardian BirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Parent/Guardian AddressParent/Guardian AddressCountryStreetCityRegionPostal CodeParent/Guardian PhoneCourse InformationIndicate below the Alvernia University courses for which the student is registering this academic year.For Example: THE 105 02 *Please note that every course is not guaranteed.Alvernia University Course Number, Section & TitleAlvernia University Course Number, Section & Title 2Alvernia University Course Number, Section & Title 3Alvernia University Course Number, Section & Title 4Signature In place of your signature, please type your full legal name. (First Middle Last)Student SignatureParent/Guardian SignatureSubmit