Application

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Thank you for your interest in Vickers Institute for Life Transitions!

 

Applications are now being accepted for summer 2018 and fall 2018.

 

The fields marked with an asterisk (*) are required.

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Undergraduate Certificate Application

Home

Thank you for your interest in Penn State World Campus!

 

Applications are now being accepted for summer 2018 and fall 2018.

 

The fields marked with an asterisk (*) are required.

 

First Name *

 

Middle Initial

 

Last name *

 

Email *

 

Phone

 

Address Line 1 *

 

Address line 2

 

Country *AFGHANISTANALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANAZORESBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEANBRITISH VIRGIN IS.BRUNEIBULGARIABURKINA FASOBURUNDIBYELARUSCAMBODIACAMEROONCANADACANAL ZONECANARY ISLANDSCANTON/ENDERBURY IS.CAPE VERDE, REP OFCAROLINE ISLANDCAYMAN ISLANDSCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) IS.COLOMBIACOMOROSCONGO (BRAZZAVILLE)CONGO (KINSHASA)COOK ISLANDSCOSTA RICACROATIACTRL AFRICAN REPUBCUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND IS-MALVINASFAROE ISLANDSFIJIFINLANDFR STHRN-ANTAR-LANDSFR TR OF AFARS&ISSASFRANCEFRENCH GUIANAFRENCH POLYNESIAGABONGAMBIAGAZAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUINEAGUINEA-BISSAUGUYANAHAITIHEARD & MCDONALD IS.HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISRAELITALYIVORY COASTJAMAICAJAPANJOHNSTON ATOLLJORDANKAZAKHSTANKENYAKIRIBATIKOREA (DPR)KOREA (ROK)KOSOVOKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAUMACEDONIAMADAGASCARMADEIRA ISLANDMALAWIMALAYSIAMALDIVESMALIMALTAMARIANA ISLANDMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMIDWAY ISLANDSMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNAVASSA ISLANDNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORWAYOKINAWAOMANPAKISTANPALAUPANAMAPAPUA NEW GUINEAPARACEL ISLANDSPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIARWANDASAINT BARTHELEMYSAINT MARTINSAMOASAN MARINOSAO TOME & PRINCIPESAUDI ARABIASCOTLANDSENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH SUDANSPAINSPRATLY ISLANDSSRI LANKAST PIERRE & MIQUELONST. HELENAST. KITTS AND NEVISST. LUCIAST. VINCENTSTATE OF PALESTINESUDANSURINAMESVALBARD & JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIATAHITITAIWANTAJIKISTANTANZANIA-UNITED REPTHAILANDTIMOR-LESTETOGOTOKELAU ISLANDSTONGATRINIDAD & TOBAGOTRUST TERR-PACIFIC ITUNISIATURKEYTURKMENISTANTURKS & CAICOS IS.TUVALUU.S.A.UGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUPPER VOLTAURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMVIRGIN ISLANDS-U.S.WAKE ATOLLWALESWALLIS & FUTUNA IS.WEST BANK JERUSALEMWESTERN SAHARAYEMEN (ADEN)ZAMBIAZIMBABWE

 

City *

 

State *- Select -ALABAMAALASKAAMERICAN SAMOAANY FOREIGN COUNTRY EXCEPT MEXICO OR CANADAARIZONAARKANSASCALIFORNIACANAL ZONECOLORADOCONNECTICUTDELAWAREDIST OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARSHALL ISLANDSMARYLANDMASSACHUSETTSMICHIGANMILITARY - ZIP RANGES 340XXMILITARY - ZIP RANGES 962XX-966XXMILITARY ZIP RANGES 090XX-098XXMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPALAUPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASTRUST TERRITORIESUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING

 

ZIP code *

 

Date of Birth *

YearYear19441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 

MonthMonthJanFebMarAprMayJunJulAugSepOctNovDec 

DayDay12345678910111213141516171819202122232425262728293031 

 

Gender *- Select -MaleFemale

 

Semester of Anticipated Enrollment *- Select -Summer 2018Fall 2018

 

Program * - Select a program -Adult Development and Aging Services (Undergraduate Certificate)Children, Youth, and Family Services (Undergraduate Certificate)Digital Arts (Undergraduate Certificate)Earth Sustainability (Undergraduate Certificate)ERP Certificate with SAP (Undergraduate Certificate)Financial Planning (Undergraduate Certificate)Information Sciences and Technology (Undergraduate Certificate)Labor Studies and Employment Relations (Undergraduate Certificate)Nursing Forensics (Undergraduate Certificate)Nursing Informatics (Undergraduate Certificate)Nursing Management (Undergraduate Certificate)Organizational Communication (Undergraduate Certificate)Security and Risk Analysis (Undergraduate Certificate)Turfgrass Management, Advanced (Undergraduate Certificate)Turfgrass Management, Basic (Undergraduate Certificate)Weather Forecasting (Undergraduate Certificate)

 

I assert that I (check all that apply)

 

 am a permanent resident of Centre County

 

 am currently attending or a graduate of a secondary school in Centre County

 

 received a high school diploma (or equivalent) more than a year ago

 

Have you ever served in the US Military? *- Select -YesNo

 

Are you currently in an academic drop status from Penn State or any other college or university previously enrolled? *- Select -YesNo

 

Have you ever been dismissed or suspended for disciplinary reasons from secondary school, Penn State, or any other institution, OR are you ineligible to return to a prior institution due to a disciplinary matter? *- Select -YesNo

 

Is there an unresolved or pending disciplinary matter at a prior institution? *- Select -YesNo

 

Have you ever pled guilty or no contest to, participated in a presentencing diversion program for, and/or been convicted of a criminal offense, OR are there criminal charges pending against you at this time? *- Select -YesNo

 

Have you ever been denied admission to Penn State? *- Select -YesNo

 

Current level of education *- Select -Earned 2-yr associate degreeEarned 4-yr baccalaureate degreeCollege graduateObtained GEDGraduated high schoolAttended post secondary schoolStill in high school

 

Have you ever enrolled at Penn State? *- Select -YesNo

 

Enter your Penn State User ID (abc123)

 

Are you a legal resident of the Commonwealth of Pennsylvania? *- Select -Yes, less than one yearYes, more than one yearNoSelect -YesNoNo Response

 

By clicking Submit below, I confirm that:

  • I have completed all applicable sections of this form and I affirm accuracy of the information provided.

  • I understand that inaccurate information provided on this form may be cause of refusal or cancellation of my enrollment.

Submit

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