Register and Apply for Admission

Please complete this form entirely before submitting. After completing the form, click Submit. Once your application has been received, an EBC Admissions Representative will contact you.

If you'd like more information before applying, contact us.

This application is secure and your information will be used for the sole purposes of applying to EBC.

Personal Information

Date of Application: 5/25/2013

Mr. Mrs. Ms.
Last Name:	First Name:	Middle Name:

Maiden Name:

Date of Birth :

Current Street Address:

Permanent Street Address:

City:

State:

Zip Code:

Home Phone:

Alternate Phone:

E-Mail Address:	Social Security Number:
Best Time to Contact You:

Residency Status:
U.S. citizen
Legal PA resident
Non-U.S. citizen permanent resident (green card)
Other
If "Other" please specify:

Educational Background

High School Graduate? Year:

GED Completed? Year: State:

High School:

City:

State:

NOTE: It is the Applicant's responsibility to have an official high school transcript and/or GED scores sent to Erie Business Center.

Have you attended college or obtained other post-secondary education?
Yes No

If yes, did you graduate ? Yes No

List institutions you have attended (Name, City, State, Dates of Attendance):
Institution 1 Name: City: State Dates:	Institution 2 Name: City: State Dates:

NOTE: It is the Applicant's responsibility to have an official transcript sent to Erie Business Center from any other institution of higher education that was attended.

Emergency Contact Information

In case of emergency, please contact the following:
Contact 1 Name: Relationship: Daytime phone:	Contact 2 Name: Relationship: Daytime phone:

Admissions Information

I am applying for admission to:

Erie, PA Campus New Castle, PA Campus

I am applying as a:

New Student (Freshman) Transfer Student

I am applying to receive:

ASB Degree Diploma

Anticipated start date:
Regular Session Fall Term (Aug.) Winter Term (Jan.) Spring Term (May)	Mid Session Fall (Oct.) Spring (Mar.) Summer (July)	Practical Nursing - Full-time, Day Program** Aug.	Practical Nursing - Part-time, Evening Program** Feb.

Class Preferences
Day Classes Evening Classes	Full-time Part-time

Special considerations (times,etc.):*

*EBC makes no guarantee that it will be able to fulfill all special scheduling requests.

**Erie Campus Only

Programs of Study

Please select the program that most interests you.

ASB Degrees

Erie Campus
Business Administration:
Accounting
Marketing
Web Design and Marketing -
Online Program

Office Careers:
Administrative Office Professional
Medical Secretary

Specialty:
Medical Assistant
Paralegal

Computer:
Information Technology

New Castle Campus
Business Administration:
Accounting
Marketing and Sales
Hospitality
Business Management

Computer Careers:
Computer Science

Office Careers:
Executive Administrative Assistant
Legal
Medical
Medical Transcription

Diploma Programs
Erie Campus Executive Secretary Home Health Aide Hotel, Restaurant & Institutional Management Medical Coding/Billing Practical Nursing Rehabilitation Technician Business Management Business Nurse Aide	New Castle Campus Personal Computers for Business Medical Coding/Billing Specialist Security and Protective Services Hotel, Restaurant and Institutional Operations

Undeclared Major
Auditing
Non-degree seeking

Financial Aid

Will you need financial aid to attend Erie Business Center?
Yes No

EBC urges all applicants to complete the Free Application for Federal Student Aid (FAFSA) as soon as possible after January 1 and before August 1.

If you are a part-time student, will you be receiving company reimbursement?
Yes No

Authorization Release

Please check all boxes below and type in your name and the application date.

I understand that I am responsible for arranging for official transcripts to be forwarded to the EBC Admissions Office.

I certify that the information given on this application is complete and correct and that I have attended no institutions other than those listed.

I hereby authorize Erie Business Center to release the following information in relation to my enrollment activities, honors, other achievements, graduation, and job placement, to newspapers and other media, my high school, and other departments within Erie Business Center: Name, Photo, Resume for Job Placement Referrals , and Place of Employment.

Erie Business Center is committed to affirmative action to assure equal opportunity for all persons, regardless of race, color, religion, national origin, or sex.

Applicant's Name:	Date of Application:
Parent/Legal Guardian: (if applicant is a minor)

Application Fee & Admissions Procedure:

Application Fee: $25
To complete your application to Erie Business Center, you must submit a $25 application fee to the campus you wish to attend. (This fee is refundable if you request cancellation within 10 calendar days of submitting an application.) Students are invited to schedule a campus visit and complete the entrance evaluation.

You may mail your application fee, process it online, or deliver it in person to the Admissions Department of the campus you plan to attend. Please make checks payable to Erie Business Center. Indicate the applicant's Social Security number on the check.

Erie Business Center
Erie Campus
246 West 9th Street
Erie, PA 16501

Erie Business Center
New Castle Campus
170 Cascade Galleria
New Castle, PA 16101

Click here to print your own copy of this form.

If you'd like more information before applying, contact us.

000 Erie Business Center • 246 West Ninth Street • Erie, PA 16501 • (814) 456-7504 or 1-800-352-ERIE