Application For Admission

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Tuition and Fees | Financial Aid | Disability Services

The links above are provided for your reference.

Note: If you are completing the application on your home computer and are called away or otherwise interrupted, your input is automatically saved. Your information is saved each time the page is closed or if you browse to another page. If you return or reopen this page within seven days, your completed information will still be here. Once submitted, or if seven days have passed, your information will be automatically deleted.

Personal Information:

Last name:

First Name:

Middle name:

Maiden Name:

Date of Birth (month/day/year):

Sex: Male Female (Select one - required):

Resident Address:

Box, Apt. or Street Name and Number:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone:

Please include your email address to receive a copy of this form after it is submitted.
Email Address:

Enrollment Information:

Please select the 'Semester and Year' that you wish to enter:

Have you previously applied to Quinsigamond Community College? Yes No
If "Yes", please indicate for which semester and year:

Have you previously attended classes at Quinsigamond Community College? Yes No
If "Yes", please indicate for which semester and year:

If "Yes", what name did you use during that enrollment?

View Programs of Study

Please select the Study Option that you are applying to.
required: Select a Degree or Certificate Option. If unsure, select "General Studies" under Degree Options

Will you attend full-time or part-time? Full-time Part-time

What is the highest diploma, degree or certificate you have achieved? Please check one of the following.

High School Diploma General Educational Development G.E.D. No H.S. Diploma or G.E.D.Certificate Associate Degree Bachelor's Degree Graduate Degree

Are you interested in receiving information about Financial Aid? Yes No

Are you interested in receiving information about Disability Services? Yes No

Are you interested in playing intercollegiate sports?
Please indicate which sport(s).

Men�s Basketball Women�s Basketball Baseball Softball

Are you a Veteran of the U.S. Armed Forces? Yes No

General Information:

What is your educational goal at Quinsigamond Community College? (Select one - required)
Receive an Associate Degree or Certificate in the program to which you applied.
Take courses to qualify for another QCC Program of Study
Please indicate desired program:

Take courses for personal or career enrichment.
Transfer courses to another institution, without receiving a degree.

Optional Information:
The following information, which is voluntary, will help us to better know our student body and enable us to comply with governmental statistical requests. Responses will not be a factor in admissions decisions made by the college, but will be made part of the Permanent Student File, which is protected by Federal and State Privacy Legislation.

Marital Status:
Single Married Widowed Separated Divorced

Ethnic Background:
American Indian/Alaskan Native Asian/Pacific Islander Hispanic
Black/Non-Hispanic Cape Verdean White/Non-Hispanic Non-Resident Alien
Other:

Please indicate the primary language spoken in your home.

Academic Information:

High School (from which you will have graduated)
If you received a GED instead of graduating High School, type GED in the "Name" field.
Name:
City: State:
CEEB # (H.S. Code number if known) Year of Graduation (actual or anticipated)

College

Name:
City: State:
CEEB # (College Code number if known)
Dates Attended: from to

College

Name:
City: State:
CEEB # (College Code number if known)
Dates Attended: from to

Have you participated in a Tech Prep/Pathways program in your high school? Yes No

How did you first become aware of the programs offered at Quinsigamond Community College? Please check those that apply.

Residency Information:

Are you a U.S. Citizen? Yes No (Select Yes or No - required)

If you selected "No" to: Are you a Citizen, please answer the following:
Are you a Permanent Resident
Yes - Enter Alien Registration #
No - Enter current Visa Type or immigration status:

Will you require a student (F-1) Visa? Yes No

*** Please check the in-state or reduced tuition eligibility category that applies to you
required:

***I have been a Massachusetts resident for six (6) continuous months and intend to remain here.

As proof of my intent to remain in Massachusetts, I possess at least 2 of the following documents, which I shall present to the institution upon request. These documents * are dated within one (1) year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution reserves the right to make any additional inquiries regarding the applicant�s status and to require submission of any additional documentation it deems necessary. Please check-off those documents you possess as proof of your intent to remain in Massachusetts. Check-off at least two.

***I am an eligible participant in the New England Board of Higher Education�s Regional Student Program.

***I am a member of the armed forces (or spouse or un-emancipated child) on active duty in Massachusetts.

***I am not a resident of Massachusetts or I have lived in Massachusetts for less than six-months.

Comment/Questions/Additional Information?

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