Online Registration Form



PERSONAL DATA
*Last Name: 
*First Name: 
Middle Name: 
Former Name: 
Birth Name: 
*Date of Birth:
Gender
*Address: 
*City: 
*State:  *Zip: 
*Home Phone: 
*Email Address: 


Citizenship Status:

Country of Citizenship:
(if not United States)

Select one or more races:

Are you Hispanic/Latino:

EMPLOYMENT INFORMATION
Employer:
Employer Address:
City:
State: Zip:
Work Phone:

EDUCATION
*Have you ever either applied to or attended LVC?
Are you and Alumnus/a of LVC?
Are you transferring these courses to another institution?
Highest Level of Education:

COURSE REGISTRATION
Semester:
Tuition will be paid:

Teachers must provide their PDE ID number
for Act 48 credit to be reported:
Course(s)
Department:
Number/Section:
Day/Time:
Credit Hours:
Audit:

 
Department:
Number/Section:
Day/Time:
Credit Hours:
Audit:

 
Department:
Number/Section:
Day/Time:
Credit Hours:
Audit:

 
Total Hours:

When you receive your invoice, please send tuition payments to the following address:

Graduate Studies & Continuing Education Office
Lebanon Valley College
101 N. College Avenue
Annville, PA 17003