Application For Admission   

 Programs of Study   |   Visit Us! QCC Tour Information
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.
Please do not fill out this application to change your major. See your advisor, or go to the advising center.
Personal Information:  Please provide your Legal Name
Last Name:    First Name:    Suffix: (Sr., Jr., etc.)
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
Degree program of study:
Certificate program of study:
Will you attend full-time or part-time?   Full-time          Part-time
Nursing Applicants only:
Will you be transferring Nursing courses?  Yes    No    Not applicable
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 

Financial Aid:
Quinsigamond Community College awards millions of dollars in Federal, State and Institutional Financial Aid each year to eligible students.  Many students, however, miss out because they do not think they are eligible and do not complete the Free Application for Federal Student Aid (FAFSA).  To apply for Financial Aid, students must complete the FAFSA available on the Federal Financial Aid Web site at www.fafsa.ed.gov .  Financial Aid can be used to pay for tuition, fees, books, transportation, and other educational expenses.

We strongly encourage you to complete the FAFSA.  If you need help with your Financial Aid application or college financial planning, our Financial Aid Office has counselors who can assist you.

Please select the option below that best describes your plans to complete a FAFSA.  This information will have no impact on whether you are admitted to the college.

I plan to apply for Federal, State and Institutional Financial Aid and am prepared to complete the FAFSA at www.fafsa.ed.gov .
 I plan to apply for Federal, State and Institutional Financial Aid, but I need help from the Financial Aid Office to complete the FAFSA.
I do not plan to apply for the Federal, State or Institutional Financial Aid at this time.
 
Are you interested in receiving  information about Disability Services?   Yes           No
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:  Please check one of the following.
Single           Married            Widowed           Separated          Divorced
Ethnic and Racial Background (Optional):
First, please designate your ethnicity:  Are you Hispanic or Latino?  Yes  No
Second, please indicate all races that apply among the following:   
American Indian/Alaskan Native        Asian       Black or African American      
Native Hawaiian or other Pacific Islander      White
 
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: 
Major:    
Dates Attended:   from to

College

Name: 
City:         State: 
Major:    
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.
Admissions Representative Alumni College Event
College Fair Community Agency Current QCC Student
Web Page Direct College Mailing Friend or Relative
High School Counselor High School Teacher Newspaper Ad
Radio Tech Prep Counselor Television
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.

Valid Driver's license

Utility bills *

Employment pay stub *

Valid Car registration

Voter registration *

State/Federal tax returns *

Mass. High School Diploma

Signed lease or rent receipt *

Military home of record *

Record of parents' residency
for un-emancipated person *

Other

  

*** 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?