Please check the class you are applying for:
Your name
If your name has been changed, please provide your name as it may appear on other records.
Sex
Are you a resident of Pennsylvania?
Your Contact Information
Current Legal Residence:

If you are under the age of 21, please identify your emergency contact.

Relationship to you:
Emergency contact information
Address
Please complete this information in accordance with federal and state reporting requirements. Information will be kept confidential.
Race
A person having origins in any of the Original Peoples of North American and who maintains cultural identification through tribal affiliation or community recognition.
A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or Pacific Islands. This includes peoples from China, Japan, Korea, the Philippine Islands, Samoa, India. and Vietnam.
A person having origins in any of the black racial groups of Africa (except those of Hispanic origin).
A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
A person having origin in any of the original peoples of Europe, North Africa or the Middle East (except those of Hispanic origin).
Tell Us About You
Education
Currently Employed?
Citizenship
A person who is a citizen or national of the United States who is in this country on a visa or temporary basis and does not have the right to remain indefinitely.
Languages
Will you be applying for Veterans Benefits?
If yes, which benefits?
Please list your significant personal achievements:
for example: participation in organizations, activities, sports, and community service, work experience as well as special awards you have earned.
High School & College Experience
Or last semester attended
Diploma/GED
Or last semester attended
Or last semester attended
None/Certificate/Associate/Bachelor/Masters/Doctorate
Documents
Upload documents as requested below. If documents cannot be uploaded here, you may email them to Wendy Joachim at wlj2@pct.edu or mail them to Penn College at Wellsboro, 22 Walnut St., Wellsboro, PA 16901.
Upload your transcript or ask your high school principal or guidance counselor to send your official high school transcript to Penn College at Wellsboro. If you have a Pennsylvania GED, submit your official score. If you do not have a PA GED, Please call us at 570-724-7703 or email to wlj2@pct.edu.
One file only.
100 MB limit.
Allowed types: pdf, doc, docx, jpg, jpeg, png.
Have your official college transcripts sent directly to Penn College at Wellsboro. If you pick them up, they must be delivered to us in an envelope SEALED directly from the college.
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Submit any other certifications or courses you have completed: CNA, MA, paramedic, EMT, or PCT.
Unlimited number of files can be uploaded to this field.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Letters of reference
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Submit two (2) letters of reference to Penn College at Wellsboro with writer’s name, address, and telephone number. If you currently work in the healthcare field, submit a letter of recommendation from your current employer/supervisor on facility letterhead and include a copy of your certification.
Signature
I certify that all information provided is complete and accurate.