LVC Visiting Graduate Student Course Request
This Course Request form is for visiting students only; this form is not intended for use by those currently enrolled in a graduate program. If you are not currently a US citizen and residing in the USA, please contact
graduateadmission@lvc.edu
for more information.
* indicates required field
Personal Information
First Name
Middle Name
Last Name
Suffix
Preferred Name/Nickname
Former Last Name/Maiden Name
Birthdate
Sex
Please select...
Male
Female
X
Pronouns
Please select...
he/him/his
she/her/hers
they/them/theirs
Gender Identity
Contact Information
Street address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Email
Primary Phone
Primary Phone Type
Please select...
Home
Mobile
Work
Can we contact you by text message? (Mobile phone number required. Standard messaging rates may apply)
Yes
No
What is your employment status?
Please select...
Student
Employed full-time
Employed part-time
Self-employed
Other
Employer name
Employer name
Position/Title
Employer street address
Employer City
Employer State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
If self employed or other, p
lease explain
If you are a PA Educator, please provide your PPID (required for ACT 48 credits)
Are you pursuing courses toward your LPC Licensure?
Yes
No
What is the highest degree you have earned?
Please select...
Bachelor
Master
Doctorate
Degree in Progress
Institution at which you earned/will earn your Undergraduate degree?
Institution Id
Have you ever attended or taken a course (for credit) at LVC?
Yes
No
How did you find out about us?
Please select...
Billboard/Commercial
Employer
I am a community member
I am a current student or alumnus of LVC
Internet Search
LVC Faculty/Staff
LVC Website
Other
Referred by a current LVC Student
Social Media
Trade Journal/Conference
Course Request Information
Term
Department
Course Name
Course Number
Course Section
Add second course request area?
Yes
No
Course Request Information 2
Term
Department
Course Name
Course Number
Course Section
Add third course request area?
Yes
No
Course Request Information 3
Term
Department
Course Name
Course Number
Course Section
Make it Official
Please check the box below to indicate your acceptance of the following statements.
•
I certify that all the information contained in this application is true and complete to the best of my knowledge
•
I understand that if the information I have provided is false, incomplete, or inaccurate, it may impact my eligibility for course
enrollment
at Lebanon Valley College
•
I understand that all documents submitted to Lebanon Valley College will become the property of the institution and will not be returned to me
I agree
Next Steps
To receive approval as a visiting student please forward an official transcript to
graduateadmission@lvc.edu
. If you are an LVC alumni your transcripts are already on file.
Your request will be evaluated soon. Upon approval you will receive a confirmation email with additional information.
If you have any questions about this form or experience any issue with submission, please contact us at
graduateadmission@lvc.edu
.