Carlow University Inquiry form for Adult Degree Students

	ADULT DEGREE INQUIRY
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Online Inquiry Form for Adult Students
For Those Who Graduated Four or More Years Ago from High School

If you graduated from high school less than four years ago, click here to go to the Traditional Day Program inquiry form.

Fill out this form to get on Carlow's mailing list and obtain an information packet about the University, and the admissions and financial aid.

Form Instructions

For text entry areas - type requested information into text entry areas.
For drop-down lists - click arrow head to right of selection to see choices; click your choice.
For radio buttons - click one radio button per question.
When you are done filling in this inquiry form, check your entries for accuracy, then click the Submit button at the end of the form or press Enter key on your keyboard 1 time

All items with an * (asterisk symbol) on this online form are required and must be completed.

CANDIDATE INFORMATION

Have you ever requested information or applied to Carlow before?* Yes No

Please indicate when you would PREFER to take classes

Student Type*

Previous Last Name (if applicable)
Last Name*
First Name*
Middle Name

Permanent Street Address
Street*
City*
State*		Zip*
County*

Phone Number*	enter in 000-000-0000 format; if no phone, enter unavailable
Work Number	enter in 000-000-0000 x00000 format; e.g. 412-555-1212 x123456
Cell Phone	enter in 000-000-0000 format
Email Address
Gender	Female Male

CITIZENSHIP

Citizen Type

EDUCATION

Do you have schooling outside of U.S.?	Yes No

Name of High School or GED*
Year of High School Graduation/GED*	enter in yyyy format

Please list in chronological order any colleges or technical schools you have attended, beyond high school.
Name of School 1
Name of School 2
Name of School 3
Name of School 4
Number of Credits Earned at colleges and/or technical schools:

Students WITH a bachelor's degree:
What's your degree?
Where is your degree from?

EMPLOYMENT INFORMATION
Current Employer

ENROLLMENT INFORMATION

Preferred location of classes All programs are not available at all sites. Choose 1st OR 1st and 2nd site from drop-down lists.		1st Choice	2nd Choice

I plan to enroll in Semester* Year*

Proposed areas of concentration include Masters, PA State Certification and Carlow-issued Certificate** programs. Please choose the concentration(s) that are appropriate.

(You can choose 1 program from each drop-down list)
Oakland Day Programs
** Involves special admission or degree completion requirements

Pre-Professional Interests
(Please choose a Major from Major Programs above as well)

Oakland Evening/Weekend Programs

Oakland Certificates**
** Carlow-issued Certificate. Does not represent a Pennsylvania state certificate.

Cranberry Evening/Weekend Programs

Cranberry Certificates**
** Carlow-issued Certificate. Does not represent a Pennsylvania state certificate.

Greensburg Evening Programs

Are you working towards your RN? *	Yes No

If so, when will you complete the RN?

Nursing (RN to BSN) Students Only
RN License Number:
Expiration Date:	Enter in MM/YY format, e.g. 12/2005

For Applicants Seeking a First Degree:

Adult Achievement Program
Check here if interested in this program that is offered through our Carlow Hill Education Center. This program is designed for adult learners who have been away from the learning environment for a number of years.

How did you first hear about Carlow?

COMMENTS

Please Check Your Entries for Accuracy Before clicking Submit button 1 time.
Please be patient after you click Submit button; It may take a few seconds or more time for the confirmation screen to appear, depending on your connection speed and Internet traffic level.

NOTE: If you see a red text message appear at top of this form after clicking the Submit button, e.g. "Please enter Your Last Name":
1. Enter a value on this form for the required field that is indicated in message.
2. Return to the bottom of this form and click the Submit button again.
3. Repeat steps 1. & 2. if another error message appears.

NOTE: Carlow University may make changes in its policies, procedures and educational offerings at any time. Carlow University reserves the right to deny or revoke admission to any applicant who does not meet admissions requirements. Carlow University does not discriminate on the basis of race, color, religion, national origin, ancestry, sex, sexual orientation, age, disability (as those terms are defined by applicable law) in the administration of any of its educational programs, activities, services, or with respect to admission or employment. For more information reqarding our equal opportunity policy, please contact our Equal Opportunity Officer at 412.578.8897 or 3333 Fifth Avenue, Pittsburgh, PA 15213.

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Carlow University is accredited by the Middle States Commission on Higher Education, 3624 Market Street, Philadelphia, PA 19104. (267-284-5000)
The Middle States Commission on Higher Education is an institutional accrediting agency recognized by the
US. Secretary of Education and the Council for Higher Education Accreditation.