Pittsburgh Admission Data Form PDF Details

The Pittsburgh Admission Data form is a foundational document for students embarking on their admission journey to the University of Pittsburgh. It encapsulates crucial personal information and academic intentions, requiring inputs such as the applicant's name, social security number, permanent address, contact information, and citizenship status, as well as parental residency details to ascertain in-state or out-of-state tuition determination. Adding to this, it probes into the applicant's planned residency during their academic tenure, be it on campus, commuting, or off-campus living. Furthermore, it delves into the financial commitment by integrating an enrollment deposit form, which is pivotal for finalizing the admission process. The deposit section calls for detailed payment information, underscoring the transaction's irreversible nature - it is both nonrefundable and nontransferable. This form not only serves as a procedural necessity, it also stands as a testament to the applicant's accuracy and honesty, with a stern reminder that falsification can lead to dismissal. Completing the circle of trust, it includes provisions for the university to seek verification of the provided data from previous educational institutions or employers. The envelopment of all these elements within the form underscores its importance as a cornerstone in the university's admissions protocol, reflecting a blend of personal declaration, financial readiness, and an acknowledgment of institutional policies governing admissions.

QuestionAnswer
Form NamePittsburgh Admission Data Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names20736 upj admission data form

Form Preview Example

ADMISSION DATA FORM

In order to complete the admission process, both the Admission Data Form and Enrollment Deposit Form, including your deposit, must be submitted.

NAME (Last, First, M.I.)

SOCIAL SECURITY NUMBER

PERMANENT ADDRESS (LINE 1)

PERMANENT ADDRESS (LINE 2)

 

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

AREA CODE, TELEPHONE NUMBER

AREA CODE, CELL PHONE NUMBER

PARENT’S E-MAIL ADDRESS

 

(

)

(

)

 

 

 

 

 

 

 

 

 

 

 

 

FOREIGN ADDRESS (Country, Zip, City, Province)

DATE OF BIRTH (mm/dd/yyyy)

/ /

SEX

FEMALEMALE

PLEASE ANSWER ALL QUESTIONS

Where are you planning to reside?

 

ON CAMPUS (1)

COMMUTE (2)

OFF CAMPUS (3)

 

 

 

 

 

 

What is your citizenship status?

U.S. Citizen

U.S. Immigrant/

 

Refugee

Nonimmigrant

Permanent Resident Alien

 

 

 

 

Are you a resident of Pennsylvania?

 

 

 

 

No, not a PA Resident

If yes, for more than one year or less than one year?

 

 

 

Yes, less than one year

(Count back from the beginning of the term for which you are enrolling.)

 

 

 

Yes, more than one year

Is your father a resident of Pennsylvania?

If yes, for more than one year or less than one year?

(Count back from the beginning of the term for which you are enrolling.)

No, not a PA Resident

Yes, less than one year

Yes, more than one year

Is your mother a resident of Pennsylvania?

If yes, for more than one year or less than one year?

(Count back from the beginning of the term for which you are enrolling.)

No, not a PA Resident

Yes, less than one year

Yes, more than one year

Is your guardian a resident of Pennsylvania?

If yes, for more than one year or less than one year?

(Count back from the beginning of the term for which you are enrolling.)

No, not a PA Resident

Yes, less than one year

Yes, more than one year

I recorded the above. The information given is true and correct. I understand that falsification of any data may result in dismissal. I authorize any employer, educational institution, or agency to release such data as is required by the University to verify any of the above information. By signing below, I also authorize the University of Pittsburgh to request and, my high school and/or testing agencies to release, any academic information or college entrance test results needed to make my admissions file complete.

Date

Student’s Signature

DO NOT WRITE IN SHADED AREA.

ENROLLMENT DEPOSIT FORM

STUDENT’S NAME (Last, First, M.I.)

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE RECEIVED (mm/dd/yy)

/

/

DEPARTMENT NAME

UNIVERSITY TELEPHONE EXT.

 

 

CREDIT CARD INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

Office of Admissions

814-269-7050

 

 

 

See instructions on back.

 

ENROLLMENT DEPOSIT

 

AMOUNT

DEPOSIT FOR

 

 

MasterCard

 

 

 

 

Visa

A

(NONREFUNDABLE/NONTRANSFERABLE)

 

TERM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CREDIT CARD NUMBER

 

 

 

 

 

 

 

 

 

TOTAL AMOUNT RECEIVED IN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$100.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check

 

MC

 

PRINT NAME AS SHOWN ON CARD

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT CHARGED

EXPIRATION DATE (mm/yy)

 

Money Order

 

Visa

$

 

 

 

 

 

$

 

 

 

 

 

 

D

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS

ACheck MasterCard or Visa.

BPrint you credit card number in the appropriate box.

CPrint cardholder’s name.

DEnter the amount to be charged.

EEnter card’s expiration date.

REMEMBER

Your bank credit card limit cannot be exceeded. If you are in doubt regarding the limit, contact your bank before completing this form.

Before the University can accept your charge, it must receive authorization from the MasterCard or Visa authorization center. If this center declines to accept your charge, we will so indicate on the deposit receipt and will return it and any other documents to you.

If your charge is declined, contact your bank for the reason. The authorization center will not give the University the reason for its refusal to authorize the charge.

The University of Pittsburgh is an affirmative action, equal opportunity institution.

UMC28084-0707