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* 1. First Name:

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* 2. Middle Name:

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* 3. Last Name:

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* 4. Date of Birth:

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* 5. Former Last/Maiden Name(s) if any:

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* 6. Permanent Address Number and Street:

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* 7. Permanent Address City or Town:

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* 8. Permanent Address State:

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* 9. Permanent Address ZIP:

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* 10. Phone Number at Permanent Address (XXX-XXX-XXXX):

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* 11. Mobile Phone Number (XXX-XXX-XXXX):

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* 12. Student Email: (Please use a non-school email address to ensure proper delivery of important messages)

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* 13. Parent Email:

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* 14. Country of Citizenship if not USA:

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* 15. U.S. permanent resident visa-List country of citizenship:

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* 16. Optional information [This information is not required to complete your application for admission.]: Are you of Hispanic or Latino ethnicity?

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* 17. Please select one (or more) race(s)/ethnicity(ies) from the following groups that you identify with:

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* 18. Sex:

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* 19. Are you a U.S. military veteran?

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* 20. Do you plan to use Veteran Benefits to fund your education?

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* 21. Have you previously applied to the University of Pittsburgh (any campus)?

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* 22. When do you seek to start this program:

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* 23. Which campus will you attend?

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* 24. If Bradford, where do you plan to live?
Please note there is no on-campus housing at Titusville

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* 25. Please list every high school, college, or university you have attended:

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* 26. RESIDENCY DATA TO BE COMPLETED BY ALL APPLICANTS: Are your parents your legal guardians?

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* 27. Do your parents/legal guardians claim you as a dependent on their federal income taxes?

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* 28. Are your parents/legal guardians residents of Pennsylvania?

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* 29. Are you a resident of Pennsylvania?

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* 30. Have you attended a college or university within the last 12 months?

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* 31. Have you been employed continuously for the last 12 months or longer?

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* 32. I understand this application will not be complete until I have submitted my final official high school transcript upon graduation (or my official satisfactory G.E.D. test result) and, if I am a transfer applicant, all final post-secondary transcripts. I understand the University will prevent my registration and/or graduation from the University should these documents not be provided. All information I have provided is true and accurate to the best of my knowledge. Signify by entering your initials and today’s date, here and click SUBMIT below.

Changes to the online application cannot be made once you click submit.  Please contact the Pitt-Bradford Office of Admissions with any questions or concerns.  admissions@upb.pitt.edu or 814-362-7555.
Statistical information concerning the graduation rate for the Titusville and Bradford campuses of the University of Pittsburgh, as required by the Student Right-to-Know and Campus Security Act, is available on request from the Enrollment Services Office, 300 Campus Drive, Bradford, PA 16701. The University of Pittsburgh, as an educational institution and as an employer, does not discriminate on the basis of race, color, religion, ethnicity, national origin, age, sex, sexual orientation or marital, veteran, or handicapped status. This is a commitment made by the University, and is in accordance with federal, state and local laws and regulations. All relevant programs are administered by the Office of Affirmative Action, 901 William Pitt Union, Pittsburgh, PA 15260. Students should contact the Office of Affirmative Action in all cases where discrimination is alleged. For more information, call (412) 648-7860.
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