Application for Admission
Bard Clemente Course in the Humanities, Holyoke
Sign in to Google to save your progress. Learn more
Email *
Personal Information
Full name *
Date of Birth *
MM
/
DD
/
YYYY
Primary phone number *
Other phone number
Email address *
Confirm email address *
Home Address *
Emergency contact (please give name, relationship, phone number)
What is your first language? *
Do you receive any sort of public assistance?
Education
Are you in school now?
Clear selection
If so, where?
Are you a high school graduate?
Clear selection
If yes, where did you go?
Did you get a GED or HiSet certificate? *
If yes, when?
Have you taken any college classes? *
If yes, when?
Name of college
How many credits?
What have been your favorite subjects in school? Why? *
What do you like to read?
Technology
Do you have access to a computer? *
Do you have a smart phone? *
Do you use email regularly? *
Do you have internet access in your home? *
If not, do you go somewhere else to access the internet? If so, where?
Family
With whom do you live?
Do you have children?
Clear selection
If yes, please list their names and ages.
Work
What types of work have you done?
Are you employed now? *
If so, where?
How many hours do you work a week at this job?
Please give the name, email, and phone number of your supervisor
Will she/he be supportive of you going to college?
Clear selection
May we speak to her/him about you?
Clear selection
Essay Questions
Please take your time to consider these. Answers should be at least two sentences (and as long as you like).
What do you hope to learn or achieve by taking the Clemente Course? Where would you like to be at the end of this school year? *
Discuss the challenges that you expect to face in the Clemente course, and what you will need to accomplish your goals. *
Would you like to share anything else with the Clemente professors?
We find that it helps students have someone in their lives who will encourage you throughout the Clemente course. If a particular person comes to mind, please give their name, your relationship, and contact information for them (phone and email address).
Finally, do you have any questions for us?
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy