Overview Course Description Course Objectives Course Requirements Course Outline Itinerary Cost Application Credits & Copyrights Back to Main Page

To register, print this page, complete form and return to: Dr. Stam M. Zervanos Penn State University Berks-Lehigh Valley College P.O. Box 7009 Reading, PA 19610 Deadline for application: January 1, 2001 Announcement of acceptance: January 15, 2001 Deposit: A check in the amount of $500 payable to Penn State University will be required upon notification of acceptance. Name Last :_________________________________________________________________ First:_______________________________________ Middle Initial:_________ Social Security #:_____________________________ Date of Birth: ______________ Parent or Guardian: ___________________________________________________ Home Address Street:________________________________________________________________ City:_________________________________ State:____ Zip:________________ Campus _______________________________________________________________ Address _______________________________________________________________ E-mail Address:________________________________________________________ Phone Number Home: (______)____________________ Campus: (______)____________________ ACADEMIC INFORMATION University now attending (if any):_____________________________________ _______________________________________________________________________ Major:_________________________________________________________________ Semester Standing:_____________________ Current GPA:___________________ I will participate as: (circle one) *Biology 297 *Biology 497 **Non-student Airport preference: (circle one) Allentown Pittsburgh Roommate preferences:__________________________________________________ Please state why you wish to take this course and how it will benefit your career goals: ____________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ * Space for each option is limited and will be assigned based on current academic standing. ** Space for this option is limited and will be assigned on a first-come basis. This page was last updated on November 8, 2000.