APPLY ONLINE

FOR THE RECORD

Title First Name Middle Name Last Name

Preferred Name

Social Security Number: (Please use 000-00-0000 format)

Gender

Permanent Address

Address
City
State
Zip

Mailing Address (if different from above)

Address
City
State
Zip

Telephone Number with Area Code

Cell Phone Number

E-mail

Date of Birth (Please use MM/DD/YYYY format)

Citizenship (if not U.S.A.)

WHAT ARE YOUR PLANS?

For which term are you applying for admission?
Spring 2009      Fall 2009

You are a Freshman Student      Transfer Student

What is your planned college residence status?
Resident/On-campus      Commuter/Off-campus      * Click here for the Lycoming College's residency policies

Do you intend to apply for need-based financial aid?
Yes      No
(If Yes, please complete the LFAA.)

What is your planned enrollment status?
Full time      Part time

Have you ever applied for admission to and /or attended Lycoming College?
Yes      No
If Yes, when?

Would you like to be considered for Lycoming academic scholarships?
Yes      No

Do you intend to apply for any of the following Lycoming talent scholarships? (* For incoming freshman studens only.)
Community Service
Choir
     Please indicate voice part:
Band
     Please indicate instrument:
Theatre

Intended college major(s): (If undecided, please indicate)

Possible career choice(s):

WHO IS TALKING ABOUT US?

Who encouraged your interest in Lycoming College?
Is this person a(n): (select all applicable)
Friend
Relative
Alumnus of Lycoming
Counselor
Lycoming coach
Current Lycoming student
Other

Did you hear about Lycoming through:
Mailings
Word of mouth
High school visit
College night
Other

Have you visited Lycoming's campus?
Yes      No
If Yes, for what purpose?

EDUCATION HISTORY

List all high schools and colleges attended, beginning with the most recent. Include date(s) of graduation or anticipated date of graduation.
School name:
School address:
Dates of attendance:
Name of advisor:

School name:
School address:
Dates of attendance:
Name of advisor:

School name:
School address:
Dates of attendance:
Name of advisor:

School name
School address:
Dates of attendance:
Name of advisor:

School name:
School address:
Dates of attendance:
Name of advisor:

TELL US ABOUT YOUR FAMILY
If you are married or were born before January 1, 1981, you do not need to complete family information.

Father's Info:
Name:
Occupation:
Employer:
Colleges attended:
Father's email:
Mother's Info:
Name:
Occupation:
Employer:
Colleges attended:
Mother's email:

With which parent do you reside?
Both     Father     Mother     Other

To whom should parent information be mailed:

Name(s):
Street address:
City:
State:
Zip:

List all brothers/sisters currently attending school (grades 9-12):

Name:
Year of high school graduation:
Mailing address (if different from yours):
Street address:
City:
State:
Zip:

Name:
Year of high school graduation:
Mailing address (if different from yours):
Street address:
City:
State:
Zip:

Name:
Year of high school graduation:
Mailing address (if different from yours):
Street address:
City:
State:
Zip:

List relatives who are currently attending Lycoming:

Name:
Relationship to you:
Year of graduation from Lycoming:

Name:
Relationship to you:
Year of graduation from Lycoming:

BRAGGING RIGHTS
List academic honors earned:

Indicate activities in which you have participated: (including clubs, sports, choir, theatre, etc.)

List volunteer and work activities in which you have participated: (organization, positions held, dates)

What do you plan on participating in at college?

PURELY OPTIONAL
You do not have to complete this section. This information is used only for the submission of governmental reports. This will not affect the admission decision.

Ethnic Group:





Religious Affiliation:

Name of Church/Temple/Synagogue:

To ensure the security of this form, please type the word "lycoming" into the text box:

By submitting this application, I certify that the information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize schools and/or colleges I have previously attended to release personal and academic information to Lycoming College.