Alumna/Alumnus making this referral
Name ____________________________________________________
Last First Middle initial
Name at time of graduation if different from above ____________________________
Address _________________________________________________________
Street / PO box / Apt. #
Address _________________________________________________________
City State ZIP code
Phone __________________________________________________________
E-mail __________________________________________________________
Year of graduation _______________________
Relationship to applicant ___________________________________________
Applicant Information
Name ____________________________________________________
Last First Middle initial
Address _________________________________________________________
Street / PO box / Apt. #
Address _________________________________________________________
City State ZIP code
Phone __________________________________________________________
E-mail __________________________________________________________
Date of birth ___________________________
PC 903.1 7/15
Thank you for helping us spread the word about Penn College!
As Penn College, WACC, or WTI alumni, you have the opportunity
to support your alma mater by referring a student to the College.
As long as we have this completed referral form on fi le by the time
your student completes an application for admission, his or her
$150 tuition deposit will be waived.
Do you know a student who would benefi t from a
Pennsylvania College of Technology education?
alumni@pct.edu
877-PCT-ALUM
Please print and mail completed form to:
Alumni Relations Offi ce DIF 62
Pennsylvania College of Technology
One College Avenue
Williamsport PA 17701-9981
