Current Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Complete Personal Information First Name Last Name Date of Birth Date of Birth: Day Day12345678910111213141516171819202122232425262728293031 Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth: Year Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Age at the time of application Are you a Pennsylvania Resident? Yes No If no, are you planning to relocate to Pennsylvania? Yes No Do you have an intellectual disability or other developmental disability? Yes No Sorry! You are not eligible to apply. Individuals with intellectual disabilities, ages 18-25, are eligible to apply to the program.For applications to other Penn State programs, contact the Office of Admissions. Please provide the specific disability Is your disability documented in the evaluation report? Yes No Personal Address Street Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone Number E-Mail Next Page >