Information:

First Name:	* Required	Peoplesoft ID #:	* Required
Middle Initial:		(7 digit number)   Call (724)-836-9905 if you have any questions.
Last Name:	* Required	Gender:	Male    Female * Required

Your class status for the semester for which you are applying:

Freshman   Sophomore   Junior   Senior    * Required

Transfer Student? Yes   No   * Required(If yes, you MUST send a copy of your unofficial transcript(s)

to 102 Village Hall,  University of Pittsburgh at Greensburg, 150 Finoli Drive, Greensburg, PA 15601)

Are you a present or former member of a Pitt-Greensburg Academic Village? Yes    No * Required

If yes, indicate Village(s) and type of membership.
BSAV	Resident Member	Non-Resident Member
HAV	Resident Member	Non-Resident Member
IAV	Resident Member	Non-Resident Member
NSNT	Resident Member	Non-Resident Member

Campus Address(if a resident)		Campus Phone
Home Address	* Required	City	* Required
State	* Required	Zip Code	* Required
Home Phone	* Required	Cell Phone
Pitt Email Address	* Required
(Any e-mails regarding this application and Village membership will be sent to your Pitt e-mail account. Please check it regularly. If you do not regularly check your Pitt account, please arrange to have Pitt messages forwarded to another account.)

II. Desired Membership Status

(You may apply for non-resident membership at anytime and to more than one Village.)

Resident Membership:

I wish to become a (read carefully and RANK your choices with 1 being your first choice. You will NOT be considered for membership in a Village you do not rank.):

-- 1 2 3 4   A resident member of the Behavioral Sciences Academic Village (BSAV)

-- 1 2 3 4   A resident member of the Humanities Academic Village (HAV)

-- 1 2 3 4   A resident member of the International Academic Village (IAV)

-- 1 2 3 4   A resident member of the Natural Sciences and New Technologies Village (NSNT)

III. Applicant Qualifications

1. QPA/SAT scores: will be checked. Transfer students should include a copy of transcripts (may be unofficial) from all transfer institutions. While there is no set minimum QPA for the Academic Villages, students with a QPA of 3.0 or higher will be given the most consideration.

2. Past participation in an Academic Village: Past membership and active participation in any Academic Village Council or Senate will be taken into consideration.

3. Essay: Your answers to the essay questions will be given strong consideration.

Click here for the a complete list of village specific qualifications

Essay Questions

IV. Agreement (please read carefully)

• I understand that acceptance of my membership is at the sole discretion of the Director of the Village(s) to which I am applying.
• If accepted as a resident member, I understand that I am expected to earn eight village attendance/participation credits, five of which must be from events sponsored by my resident Village or service to it. I also agree to be a respectful village resident and abide by all Pitt-Greensburg housing rules.
• I understand that violations of University and/or Residence Life policies may result in removal from the villages.
• If accepted as a nonresident, I must earn five village attendance/participation credits, three of which must be from events sponsored by my resident Village or service to it.
• I understand that credit can be earned through attending programs, service on a Village student council or senate, or any other forms of participation for which the village director agrees to grant credit.
• I understand that my membership in the Academic Villages may be terminated if I do not fulfill the above conditions. In addition, if I am living in Village housing, I understand that I may be reassigned to non-Village housing for violating these requirements.

  
APPLICANT'S SIGNATURE:                     Date: 
(typing your name in this field will serve as your signature)