Peru State College
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Undergraduate Application for Admission & Scholarships

 

Peru State College is an equal opportunity institution. PSC does not discriminate against any student, employee or applicant on the basis of race, color, national origin, sex, disability, religion, or age in employment and education opportunities, including but not limited to admission decisions. The College has designated an individual to coordinate the College’s nondiscrimination efforts to comply with regulations implementing Title VI, VII, IX, and Section 504. Inquiries regarding non-discrimination policies and practices may be directed to Eulanda Cade, Director of Human Resources, Title VI, VII, IX Compliance Coordinator, Peru State College, PO Box 10, Peru, NE 68421-0010, (402) 872-2230

 

Not all courses and programs are offered at all locations. Please call 1-800-742-4412 for specific information on courses and programs of study.

 

International students can not submit an on-line application. Please go to the International Student section on the admissions page to find the printable application.

 

I will be attending Peru State College in the following way
 
Legal Name
First Name, Middle Name: ,
Last Name:
Social Security Number: i.e. 555-55-5555
Gender: female male
Martial Status:
Maiden Name:
Birth Information
Birth Month, Day, Year: , ,
Permanent Address
Address:
City, County: ,
State, Zip: ,
Phone Number: i.e. 555-555-5555
Email Address:
Current/Mailing Address (if different from above)
Address:
City:
State, Zip: ,
Phone Number: i.e. 555-555-5555
Next of Kin (notification in case of emergency)
Relationship:
Name:
Address:
City:
State, Zip: ,
Phone Number: i.e. 555-555-5555
Citizenship / Visa Type
Are You a U.S. Citizen: yes no
If Not: Country:
Visa Type, Expiration: ,
If you are an international student interested in an I-20 from Peru State College you can not submit this application. Please go to the international student section on the admissions page to find the printable international student application.
Background Information
Have you ever been convicted of, or are you currently under indictment for, a felony? (if yes, please supply a complete letter of explanation specifying the crime, docket or case number, court(s) of jurisdiction, and sentence or other remedy imposed.)
  yes no
n compliance with Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972, this information is for reporting purposes only.
(optional) Ethnic Background:
High School Information
Name of High School :
City:
State, Zip: ,
Graduation Date: e.g. May 2009
ACT / SAT / GED Scores
(ACT) Completed: yes no
(ACT) Total Score:
(ACT) Date Taken: i.e. mm/yy
(SAT) Completed: yes no
(SAT) Verbal Score:
(SAT) Math Score:
(SAT) Date Taken: i.e. mm/yy
(GED) Completed: yes no
When do you want to start classes?
Enrollment Semester:
Enrollment Type:
Expected Grade Level:
Are you interested in Credit for Life Experience? (Credit for Life Experience is intended for individuals with significant professional experience)?
  yes no
Academic Major Information
Students interested in management and are transferring to Peru with AAS degrees or significant technical credits and life experience should select the ASMG degree. An asterisk (*) denotes a major that is also available online.
1st Academic Major:

2nd Academic Major:

(double major only)

Academic Minor:
List All Colleges Previously Attended (if necessary)
Are you in good standing at your previous post-secondary institutions? (Good standing means not being suspended for academic or disciplinary reasons)
  yes no n/a
Institution Name:

City, State:

 ,
Dates of Attendance:
Credits Earned:
Degree Earned:
Institution Name:

City, State:

 ,
Dates of Attendance:
Credits Earned:
Degree Earned:
Institution Name:

City, State:

 ,
Dates of Attendance:
Credits Earned:
Degree Earned:
Institution Name:

City, State:

 ,
Dates of Attendance:
Credits Earned:
Degree Earned:
Institution Name:

City, State:

 ,
Dates of Attendance:
Credits Earned:
Degree Earned:
Nebraska Residency
Nebraska Resident:

Length of Residency:

(years)

Housing Information
I Plan To:
Scholarship Awarding
Are you the first in your family to attend college?
  yes no
Do you or your family actively participate in a farming operation?
  yes no
Do you plan to participate in intercollegiate athletics at Peru State College?
  yes no

Are you a member of Phi Theta Kappa Honor Society? (transfer students only)

(Please submit a copy of your PTK membership card to be considered for this scholarship.)
  yes no

How many activities/organizations are you currently involved in?
 

Please list those activities/organizations
 
Optional
How did you hear about PSC:
Certification
I certify that the information that I provided on this application is complete, accurate and true. I agree to abide by the policies and regulations of Peru State College. I understand that any information given falsely or withheld will affect the decision on my application and make me ineligible for admission and/or enrollment or may be grounds for dismissal following enrollment. In order to promote academic integrity, the college subscribes to an electronic service to review papers for the appropriate citations and originality. Key elements of submitted papers are stored electronically in a limited access database and thus become a permanent part of the material to which future submissions are compared. Submission of an application and continued enrollment signifies your permission for this use of your written work.