Greatest elevation change: Nearly 1100 ft.
Average Grade: 3%. But that's average. Here are some of the local grades:
 

Ascent of Little Flat:	The first hill rises 772 feet in the first 5 kilometers from the starting line. The average grade is 5%, and is significantly steeper in parts.
Descent to Whipple Dam:	The long downhill to Whipple Dam from Little Flat descends nearly 1100 ft in 7.6 miles, an average 2.7 % grade.
Beidleheimer Road:	At mile 15 on Beidleheimer Rd there is an ascent of 480 ft in 1.4 miles. Grade: 6.5%. The long downslope to mile 21 descends just over 500 ft in 4.7 miles. Grade: 2%
Penn Roosevelt Hill:	The big hill in the middle of the course starts ascending at mile 21 and finishes 930 ft higher at the start of mile 29 on Crowfield Rd a couple of miles past Penn Roosevelt State Park. Grade: 2.3%. But don't let the low number fool you! The long hills wears you down, and there are some steep sections. The downhill side is an easy descent of nearly 700 ft in about 8.7 miles.
Bear Meadows Bedevilment:	The final long uphill starts on Krise Valley Rd at mile 37. It ascends 800 ft in 5.8 miles. The peak is on Treaster Kettle Rd near Bear Meadows Rd. Grade: 2.6%. The last bit is the steepest. After a short descent on Bear Meadows Rd to the turnaround on Wampler Rd, the course revisits the peak from a different side. Ascending Bear Meadows Rd., the high point is just past its intersection with Treaster Kettle Rd. The final downhill on Bear Meadows Rd descends 740 ft in just under 5 miles. Grade: 3%

 

There is a very detailed description of the course, including landmarks, on the Tussey mOUnTaiNBACK Relay web site. There is also a jumbo version of the course map shown below.