Springfield College/Undergraduate On-line Application Form/Freshman

Undergraduate On-line Application Form

Freshman

Office of Admissions
263 Alden Street Springfield, MA 01109-3797
TEL: (800)343-1257 / (413)748-3136

Name:
Last Name:	First Name:	Middle Name:

Date of Birth:
Social Security Number:

Home Address	Number and Street:	City:	State:
Zip:		Country:
Home Telephone:		-	-
Mailing Address (if different)	Number and Street:	City:	State:
Zip:		Country:
Telephone:		-	-

E-mail Address:

Sex:	Male Female	Housing Preference:	Resident Commuter
Military Status:	Non-Veteran Veteran	Date of Discharge (Month/Day/Year):
Anticipated Enrollment
Month:	September January	Year:
Do you wish to apply for Early Decision (Deadline: December 1)?	Yes No	Are you a U.S. citizen/permanent resident?	Yes No
-		If not U.S. citizen, please indicate country of present citizenship:

What most influenced this application?

If you chose "Other," please describe.

Please list all secondary schools you have attended, grades 9-11:

Name of School (present):	Location (City, State, Zip):	Dates Attended (Month/Day/Year):

Name of School:	Location (City, State, Zip):	Dates Attended (Month/Day/Year):

Present School CEEB Code Number:	Public/private:	Graduation Date (Month/Day/Year):
	Public Private

If you have taken courses for college credit while in high school, how many credits do you anticipate receiving?

credit(s)

If you wish to identify yourself as a member of a racial or ethnic group, please indicate: (Optional)
What are your plans for the summer immediately preceding your September enrollment?

What part-time employment have you had while attending school?

	Name of Employer:	Your Position or Duties:	Hours per Week:
Employer1:
Employer2:
Employer3:

Are you presently working?	Hours per Week:	Reason for Working:
Yes No

If not presently enrolled in any school, please account for your time (jobs, additional studies, etc. since high school graduation in chronological order.

Have you been suspended or dismissed from any school for any reason?	Yes No	If yes, please explain:
Have you previously applied to and/or registered for any courses at Springfield College?	Yes No	If yes, please indicate date of application and/or registration and whether for regular year, summer school, or evening school.

Father or Guardian:

Name:	Living? Yes No	Occupation:
Home Address
Number and Street:	City:	State:	Zip:

Mother or Guardian:

Name:	Living? Yes No	Occupation:
Home Address
Number and Street:	City:	State:	Zip:

Number of brothers and sisters:	Older than self:	Younger than self:	At home:

Athletics:

	Sport:	Intramural:	Years of Varsity (Participation):	Varsity (Letters)	Captain	Honors (Explain)
1		Yes			Yes
2		Yes			Yes
3		Yes			Yes
4		Yes			Yes
5		Yes			Yes

Publications:

Years of Participation	Sub Editor (Give Position)	Year	Editor in Chief	Year
			Yes
			Yes

Student Government: (Enter year - freshman, sophomore, junior, senior - in boxes)

Student Council/Government

Pres.	V. Pres	Sec.	Treas.	Rep.	Other (Explain)

Class Government

Pres.	V. Pres	Sec.	Treas.	Rep.	Other (Explain)

Other Activities: (School and community - band, YMCA, YWCA, glee club, scouting, dramatics, church, tutoring, etc.)

Activity	Dates of Participation	Offices Held	Honors or Titles Awarded (Explain)

Indicate your choice of program.
updated: 01/31/06

Profession or vocation you plan after graduation:
Alternative:
Are you considering a career in the YMCA?	Definitely Possibly No

If you have relatives who attended Springfield College, please list them giving relationship and class year (if known).

Please give the name and address of a Springfield College alumnus/a you have known best (other than a relative).

Name:
Address:
	Submission Date (EST): 07/20/2008 05:05 PM