Trinity College by YH95e8

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									Trinity College
Hartford, CT 06106                        Term Applying For: __________________

Application for New Non-Matriculated Undergraduate Students (please print)

Name: _________________________________________________________________________

Permanent Mailing Address: ________________________________________________________

                          _________________________________________________________

Local address (if different): _________________________________________________________

                          _________________________________________________________

E-mail address: ___________________________________________________________________

Phone: Home ______________________ Work __________________ Cell __________________

Have you previously applied to or attended Trinity College? __________ If yes, when?_________

Are you a Trinity employee? ___________ If yes, what department? ________________________

Are you related to a Trinity employee? _______ If yes, name and department __________________

Previous Education (including high school)
Institution                                                    Dates                Degree?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Briefly, why do you wish to enroll at Trinity? ___________________________________________

________________________________________________________________________________

________________________________________________________________________________



________________________________________________________________________________
Signature                                             Date
                                                                        (over)
Emergency Contact Information: Name _____________________________________________

Relationship _________________________ Telephone __________________________________

Student Information

Social Security Number: _________________________ Birth date: _________________________

Gender: ________________________ Marital Status : ______________________________

Citizenship: _________________ If Foreign, Visa Type/Exp.Date: __________________________

Ethnic Origin (check one)

_____ Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East,
      Southeast Asia, the Indian Subcontinent or the Pacific Islands. This includes people from China,
      Japan, Korea, the Philippine Islands, American Samoa, India and Viet Nam.
_____ Black – All persons having origins in any of the black racial groups of Africa (except those of
      Hispanic origin).
_____ American Indian or Alaska Native – All persons having origins in any of the original peoples of
      North America, and who maintain cultural identification through tribal affiliation or community
      recognition.
_____ Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other
      Spanish culture or origin, regardless of race.
_____ White – All persons having origins in any of the original peoples of Europe, North Africa or the
      Middle East (except those of Hispanic origin).
_____ Minority, multicultural - All persons whose ethnic origins can be defined as more than one of the
      above categories

Military Description:
_____ Veteran eligible for benefits              _____ Dependent of deceased war veteran

_____ Reservist eligible for benefits            _____ Vocational Rehabilitation

Directory Information
You have the right to withhold your name and any or all directory information (e.g. address, phone
number etc.) from the NEXT publication of the Trinity College Directory. Note: If you choose to
withhold all information, even your name will be withheld.

Please indicate if you would like to have any of the information withheld:
_____ Do not release ANY directory information
_____ Do not release address information
_____ Do not release telephone number(s)

								
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