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2012-13 First-year Application
For Spring 2013 or Fall 2013 Enrollment

APPLIC ANT
Lagun Srijana Legal Name ___________________________________________________________________________________________________________________ Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Preferred name, if not first name (only one) ____________________________ 05/07/1996 Birth Date ____________________________________________________ Female Male mm/dd/yyyy

Former last name(s) _____________________________________________ US Social Security Number, if any ___________________________________ Required for US Citizens and Permanent Residents applying for financial aid via FAFSA

Preferred Telephone

Home

570 344 7327 570 6775363 Cell Home (_______) __________________________________ Cell (_______) __________________________________ Area/Country/City Code Area/Country/City Code

E-mail Address surangle@yahoo.com ________________________________________________ Number & Street City/Town County or Parish

IM Address _____________________________________________ _______ Apartment # State/Province Country ZIP/Postal Code

840 clay ave 3 Permanent home address _________________________________________________________________________________________________ _______ __ Scranton Pennsylvania 18510 ____________________________________________________________________________________________________________________________ If different from above, please give your current mailing address for all admission correspondence. (from ___________ to ___________) (mm/dd/yyyy) Number & Street City/Town County or Parish State/Province Apartment # Country ZIP/Postal Code (mm/dd/yyyy)

Current mailing address __________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ If your current mailing address is a boarding school, include name of school here: ______________________________________________________________ _ __

FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants. 09/30/2013 College Penn State ________________________________________________________ Deadline ______________________________________________________ mm/dd/yyyy

Entry Term:

Fall (Jul-Dec)

Spring (Jan-Jun)

Do you intend to apply for need-based financial aid? Do you intend to apply for merit-based scholarships? Do you intend to be a full-time student? Do you intend to enroll in a degree program your first year?

Yes Yes Yes Yes

No No No No

Decision Plan___________________________________________________ Regular

Science,Math,English,Economy,and sports etc.. Academic Interests _____________________________________________ ____________________________________________________________ ____________________________________________________________

yes Do you intend to live in college housing? ______________________________

Physician Career Interest_________________________________________________

Bachuler What is the highest degree you intend to earn? _________________________

DEMOGRAPHICS
Citizenship Status ______________________________________________ Non-US Citizenship(s)Non ____________________________________________ _____________________________________________________________ _____________________________________________________________ Birthplace Pathri ________________________________________________________ Jhapa Nepal City/Town State/Province Country

1. Are you Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No If yes, please describe your background.

____________________________________________________________...
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