| | | FIRST NAME MIDDLE INITIAL LAST NAME PSU SID | STREET ADDRESS TELEPHONE | | | CITY Zip Code CELL PHONE | - - PRIMARY EMAIL ADDRESS BIRTH DATE | DATE OR TERM ADMITTED TO PSU IF ADMITTED WITH CONDITIONS PLEASE LIST THE CONDITIONS: | HIGH SCHOOL ATTENDED GRADUATION DATE | | COLLEGE(S) ATTENDED CREDITS DATES | | COLLEGE(S) ATTENDED CREDITS DATES | | COLLEGE(S) ATTENDED CREDITS DATES | COLLEGE CREDITS TOTAL INTENDED MAJOR(S) OR AREA OF STUDY Highest in school your father or guardian completed: Highest in school your mother or guardian completed: Master’s/Ph.D./M.D./J.D. Master’s/Ph.D./M.D./J.D.   Bachelor’s degree from a U.S. College or University Bachelor’s degree from a U.S. College or University   Bachelor’s degree from country outside the U.S. Bachelor’s degree from country outside the U.S.   Some college/Associate’s degree Some college/Associate’s degree   High school/GED High school/GED   Did not graduate from high school Did not graduate from high school   Unknown Unknown  
| | | FIRST NAME MIDDLE INITIAL LAST NAME PSU SID | STREET ADDRESS TELEPHONE | | | CITY Zip Code CELL PHONE | - - PRIMARY EMAIL ADDRESS BIRTH DATE | DATE OR TERM ADMITTED TO PSU IF ADMITTED WITH CONDITIONS PLEASE LIST THE CONDITIONS: | HIGH SCHOOL ATTENDED GRADUATION DATE | | COLLEGE(S) ATTENDED CREDITS DATES | | COLLEGE(S) ATTENDED CREDITS DATES | | COLLEGE(S) ATTENDED CREDITS DATES | COLLEGE CREDITS TOTAL INTENDED MAJOR(S) OR AREA OF STUDY Highest in school your father or guardian completed:  Master’s/Ph.D./M.D./J.D.  Bachelor’s degree from a U.S. College or University  Bachelor’s degree from country outside the U.S.  Some college/Associate’s degree  High school/GED  Did not graduate from high school  Unknown Highest in school your mother or guardian completed:  Master’s/Ph.D./M.D./J.D.  Bachelor’s degree from a U.S. College or University  Bachelor’s degree from country outside the U.S.  Some college/Associate’s degree  High school/GED  Did not graduate from high school  Unknown
2017-2018%20Current%20PSU%20%26%20Transfer%20Diversity%20Scholarship%20Application.docx