Online Application, Apply Online:: Erie Business Center

Application for Admission

Please complete this form entirely before submitting. Note the information at the end of the form regarding the Application Fee and Admissions Procedure. After completing the form, click Submit. Once your application has been received, an EBC Admissions Representative will contact you.
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Personal Information

Social Security Number:

Date of Application: 2/9/2010

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:

Work Phone:

E-Mail Address:

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 Aug. 2009

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 programs of interest to you.

ASB Degrees

Erie Campus
Business Administration:
Accounting
Marketing

Office Careers:
Administrative Office
Professional
Medical Secretary
Medical Transcription

Specialty
Medical Assistant
Paralegal

Computer
Information Technology

New Castle Campus
Business Administration:
Accounting
Marketing and Sales
Travel and Tourism

Computer Careers:
Computer Science
(Programming)

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 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

Are you a touch typist? Yes No If Yes, how many wpm

I am aware that I may have to take some evening classes during my education at EBC.

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 hereby authorize EBC to request the release of my high school transcripts and all final grades to be forwarded to Erie Business Center.

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

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 or will be living in EBC student housing)

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 also required to schedule a campus tour and participate in an entrance evaluation.

You may mail your application fee 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

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