Misericordia University Young Scholars Application Form (2023-2024)

Complete the form below to apply to Misericordia University's Young Scholars program. If you have any questions please contact Jeff Demko in the Center for Adult and Continuing Education at jdemko@misericordia.edu or 1-570-674-3020.

*Denotes a Required Field

Student Information

Legal First Name*

Legal Middle Name

Legal Last Name*

Suffix

Preferred First Name

Student Birthdate*

Gender

Student Email*

Social Security Number* (required to register for classes)

Student Contact Information

Student Phone Number*

Phone Type*

Student Mailing Address*

Country

Street

City

Region

Postal Code

Student Permanent Address*

Same as Student Mailing Address*

Country

Street

City

Region

Postal Code

Current Academic Information

Current School Name*

CEEB: (Hidden)

Expected Year of Graduation*

Guidance Counselor Name*

Guidance Counselor Email*

Program Information

Application Academic Year*

When would you like to start your course(s)? *

Would you like to be contacted by a Young Scholars Admissions Counselor?

Are you considering Misericordia University for your undergraduate degree?

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Misericordia University Young Scholars Application Form (2023-2024)

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