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BIOGRAPHICAL & CONTACT INFORMATION

Referring Agency (if relevant)

Name

First Last

Prefer to be called

Email

Date

MM/DD/YYYY

We Chat ID:

Country of Citizenship

Country of Birth

Date of Birth

MM/DD/YYYY

Are you also a citizen or permanent resident of the United States?*

Yes
No

Gender:*

Male
Female

OFFICIAL HOME ADDRESS

(The address that will appear on your enrollment documents)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ARRIVAL DATES & HOUSING

Indicate preferred start month and year

Arrival date:

January
Late August
May

Year

ACADEMIC PLAN

Indicate your choice of major field of study. Indicate ‘Exploratory’ if not certain.

UNIVERSITY PREFERENCE

Indicate below your top three choices of universities you are considering transferring upon completion of the University Abroad Programs. You may also check ‘Uncertain at this point’.

Champlain College - Burlington, Vermont
Emerson University - Boston, Massachusetts
Muhlenberg College - Allentown, Pennsylvania
Quinnipiac University - Connecticut
Saint Michael’s College - Colchester, Vermont
Washington and Jefferson College - Washington, Pennsylvania
Uncertain at this point. I will decide later.

EDUCATIONAL BACKGROUND

List all the educational institutions you have attended starting with secondary school and include any institution you are currently attending.

Name of institution

City, Country

Dates of Attendance From / To

Diplomas or Certificates

Year of Graduation

Name of institution

City, Country

Dates of Attendance From / To

Diplomas or Certificates

Year of Graduation

Please consider me for a merit based scholarship:*

Yes
No

ENGLISH LANGUAGE LEVEL

Please provide a test score report if available. Test score not required for International & Preparatory levels

Score of most recent English-Language Test

Name of Test

Date of Test

STUDENT DECLARATION

Failure to provide complete and accurate answers on this Application may be considered grounds for dismissal from Saint Michael's College. The undersigned further agree that the candidate, if accepted, will abide by all rules and regulations governing the student body at Saint Michael's College.

Applicant’s Signature

Signature of Applicant’s Parents or Guardians if under 18

Online Application