Springfield College/Undergraduate On-line Application Form/Transfer

Undergraduate On-line Application Form

Transfer

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

Name:
Last Name:	First Name:	Middle Name:

Social Security Number:

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

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:
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.

Date of High school or GED completion

Please list all colleges you have attended, starting with most recent.

Name of College		Location (City, State, Zip)	Dates Attended	Full-time/part-time
	Two-year institution Four-year institution			Full-time Part-time
	Two-year institution Four-year institution			Full-time Part-time

Anticipated amount of academic credit to be transferred:	credits	-
Have you previously applied to Springfield College?	Yes No	Date:
Have you previously registered for courses at Springfield College?	Yes No	Date:

If you wish to identify yourself as a member of a racial or ethnic group, please indicate: (Optional)

Employment History

1. Current Employer

Company:	Address:
Job Title:
From To	Full-time/part-time Full-time Part-time
Responsibility:

1. Previous Employer

A. Company:	Address:
Job Title:
From To	Full-time/part-time: Full-time Part-time
Responsibility:
B. Company:	Address:
Job Title:
From To	Full-time/part-time: Full-time Part-time
Responsibility:

Community Service/Volunteer Work/School Activities:

Please indicate participation in community activities. Examples include YMCA, YWCA, scouting, dramatics, church, tutoring, athletics, etc.

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).