Walk-In Registration Form

All information must be completed

*** Note: Non-degree students are not eligible for state and federal financial aid.***

Courses to be enrolled:  Undergraduate  Graduate

Have you ever applied for formal admission to Lock Haven University? No  Yes  

Previous College/University Attendance:

College/university name and address:
college_university_address

Degree and date earned, if applicable:
degree_date_earned

Semester and year for which you are registering:  Fall Winter_Intersession Spring Summer_1 Summer_2 Summer_Extended         Year:        

Social Security Number: [will be used as student identifier until LHU student ID number is assigned]    

Warning:  You are submitting information over an unsecure site; if you choose not to provide your social security number, you will be contacted for the number by telephone.

Name :     

Maiden Name: (if applicable)  

Street Address:  

City:    State:     Zip:  

Telephone Number: (including area code)    

Cell/Mobile Phone Number: (including area code)    

Date of Birth:  (include month, day & year)           

Business Telephone Number: (if applicable)     

Residency Status (County, State, Country):

Local Address: (if different from above) 

Street or PO Box:  

City, State, Zip:  

Phone: (including area code)  

Have you ever been convicted of a criminal offense*?  
     If yes, please state the criminal offense and when it occurred:
     Date:

     Essay:
     offense_essay

*A criminal offense is defined as a felony.  Please disregard:  minor traffic violations, offenses committed before your 18th birthday which were adjudicated in juvenile court under a Youth Offender Law, and any charges which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition Program.
A conviction is an adjudication of guilt and includes determinations before a court, a district justice or magistrate and pleas of  nolo contendre (no contest).

 
US Department of Education Questions

What is your ethnicity?     Hispanic or Latino        Not Hispanic or Latino

What is your race?  Mark one or more races to indicate what you consider yourself to be. 
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Sex: Female Male      Email Address:   

Marital Status:  Not Indicated Single Married Divorced Widowed   (If you choose not to provide this information, select "not indicated.") 
         

High School Information

Name and address of high school:
HS_name_address

Date of high school graduation:

Course Choices (Note: Math courses require proof of having the prerequisite or completion of LHU's math placement exam.)

1st Choice (course # & sec):             
Alternate Choice (course # & sec):      

2nd Choice (course # & sec):              
Alternate Choice (course # & sec):     

3rd Choice (course # & sec):              
Alternate Choice (course # & sec):      

4th Choice (course # & sec):              
Alternate Choice (course # & sec):      

5th Choice (course # & sec):             
Alternate Choice (course # & sec):