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Application For Admission |
Programs of
Study |
Visit Us! QCC Tour Information
Tuition and Fees
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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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Personal Information: |
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Last name:
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First Name:
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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 |
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| 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
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| 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 |
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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:
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:
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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:
CEEB # (College Code number if known)
Dates Attended: from
to
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| College Name:
City:
State:
CEEB # (College Code number if known)
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) |
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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A Community of Support. A World of
Possibilities. |