(*) denotes required information.

Online Application for Admission

 

  
   
Personal Information

* Last Name:  

* First Name:   

* Gender:    

* Birth date (xx/xx/xxxx):    

* Address:     

* City:     

* State:    

* Zip:    

* Email:     
* Phone:    
* Country of Citizenship:    
Alien Reg. # (if U.S. permanent resident. International students only.): 
 
* Is English your primary language?     
TOEFL date (If taken. International students only): 
 
* Are you Hispanic or Latino? (Select Yes or No):     
If you answered Yes, please describe background: 
 
** Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you:
Asian
Black or African American (including Africa and Caribbean) 
Native Hawaiian or other Pacific Islander (Original Peoples)
White (including Middle Eastern)
Race or ethnicity unknown
American Indian or Alaska Native (including all Original Peoples of the Americas)
If you selected American Indian or Alaskan Native and are enrolled, please enter tribal enrollment number:
   
Applicant Information
*What type of admission are you applying for?  
If Weekender, please choose location:   La Plume Towanda
* Are you applying as a First Year Student or Transfer?  
*What semester are you applying for?  
*Will you be living on-campus or commuting?  
If you have previously attended Keystone, please provide dates of attendance:
   
Educational Information
High School Information
*High School Attended:  
 Address of High School:
*City:  
* State:  
 Zip:
* Did you graduate?  
Date of Graduation:
Date of GED completion (if applicable):
GED Score (If applicable):
* Did you take the SAT?  

Previous College Experience
College Attended:
Address (City, State and Zip):
Dates Attended:
Number of Credits or Degree earned:
   
College Attended:
Address (City, State and Zip):
Dates Attended:
Number of Credits or Degree earned:
 
Personal Activities

Extra Curricular Activities (list position held if applicable):

 
Volunteer for Organization (position & tasks):

   
Financial Aid Information
* Do you plan to apply for Financial Aid?  
* Have you ever been a member of the U.S. Armed Forces?  
If yes, dates of service.
* Does your employer or your parents' employer offer tuition assistance?  
* Will you receive tuition assistance from OVR, WIA & NAFTA (TAA)?  
* Have you ever been found responsible for a disciplinary violation at any secondary school you have attended, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?  
* Have you ever been convicted of a misdemeanor, felony, or other crime?  
   
Family Information
Mother's Name:
Mother's Address (if different):
Mother's Phone:
Mother's Employer:
College Attended and Degree Earned by Mother:
   
Father's Name:
Father's Address (if different):
Father's Telephone Phone:
Father's Employer:
College Attended and Degree Earned by Father:
   
Name of Guardian (if other than parent):
Relationship to your Guardian:
Guardian's Address (if different):
Guardian's Phone:
Guardian's Employer:
College Attended and Degree Earned by Guardian:
   
Preferred Parent Email::
Name of Applicant's Spouse (if applicable):
Address of Spouse (if different):
 

Please list any relative or close friend who attends/attended Keystone College (list your relationship):
 
* Who or what most influenced your decision to apply to Keystone College?      
   
Intended Major
You must select one of the following intended areas of study:
* Intended Major:     
* I am interested in:    
  *  If you are interested in participating in athletics at Keystone, choose the sport you hope to pursue:      
   

Thank you for taking the first step in pursuing an educational experience with Keystone College..
A non-refundable $30 application fee must accompany this application. Make check or money order payable to Keystone College. Also, provide an official copy of your high school transcripts, SAT or ACT test scores, and transcripts from any or all colleges and universities attended. Your application will not be processed until all documents have been received.
  • I understand that all Keystone literature is intended for informational purposes, is subject to change and therefore does not constitute a contract between the College and its students.
  • I authorize Keystone College to publish for public relations purposes any photograph in which I may appear.
  • I hereby apply for admission to Keystone College and agree to abide by its regulations. I certify that the information given on this form is complete and accurate.
  • I understand that I may be subject to disciplinary action, including admission revocation or expulsion, should the information I have certified be false.
**Signature of Applicant:  
Signature of Parent or Guardian (if applicant under 18 years):