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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. |
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Please do not fill out this application to change your major. See your advisor,
or go to the advising center. |
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Personal Information: Please provide your Legal Name |
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Last Name:
First Name:
Suffix:
(Sr., Jr., etc.) |
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Middle Name: |
Maiden Name:
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| Date of Birth
(month/day/year): |
| Sex:
Male
Female (Select one - required): |
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Resident Address: |
Box, Apt. or Street Name and Number:
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City:
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| State:
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Zip
Code: |
| Home Phone:
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Work Phone:
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Cell Phone:
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Please include your email address to receive a copy of this form after it is
submitted.
Email Address:
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Enrollment Information:
Please select the 'Semester and Year' that you wish to enter: |
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Have
you
previously applied to Quinsigamond Community College?
Yes
No
If "Yes", please indicate for which semester and year:
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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?
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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:
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Certificate program of study:
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| 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
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| 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
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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.
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| Are you
interested in receiving
information about Disability Services?
Yes
No |
| Are
you a Veteran of the U.S. Armed Forces?
Yes
No |
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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
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Please indicate
the primary language spoken in your home.
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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)
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| College
Name:
City:
State:
Major:
Dates Attended: from
to
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| College
Name:
City:
State:
Major:
Dates Attended: from
to
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| 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.
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Residency Information: |
| Are you a U.S.
Citizen?
Yes
No
(Select Yes or No - required) |
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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:
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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. |
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***
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.
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Comment/Questions/Additional Information?
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