Interest Survey: PA Pathways to College Pilot
College readiness and preparation program for the formerly incarcerated who express the desire to pursue a degree across the Commonwealth.
Sign in to Google to save your progress. Learn more
Email *
First & Last Name *
Preferred Email
Mobile Number *
Please write county of current residency *
Examples: Leigh County, Philadelphia County, Centre County, Delaware County, Montgomery County, Allegheny County .
Are you formerly incarcerated? NOTE: This program is designed for formerly incarcerated individuals and will work towards meeting the needs of this population. *
Willingness to explore college degree options: *
Highest level of education attained: I have *
I am also interested in being selected for a 3 Day Campus Visit to Penn State (includes overnight accommodations)
In April 2022, we're are hosting a 3 day campus visit for formerly incarcerated students interested in college. We're trying to gage your general availability and interest in attending the workshop. If selected to participate, we would cover the cost of hotel and transportation.
Clear selection
During incarceration, I participated in the following course offerings: *
What is your racial/ethnic background? *
When did you complete your education? *
When was the last time you were enrolled in school? *
What are your career/educational goals?
Any other information you'd like us to know/consider?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy