Fellow Application (DOC)

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					                          Trinity College – email to
  Candidate    Submit with this application, the following:
    Form –        1. A complete resume with dates of employment
 Membership       2. An autobiography on your achievements and contribution to society
in the College    3. Proof of graduation from a PhD (or equivalent) program
  of Fellows      4. This application with all answers properly completed
Name:             Please indicate name as it appears on your Social Security card or Passport, if applicable.

                   Last/Family                   First/Given                  Middle    Former/Maiden, if any

Date of Birth     __________________Email Address __________________________________

                  Street/Apt. No.

                   City                    State/      Zip/Postal        Country
                                           Province    Code

Phone Number
                             -      -      ____

Phone Number
                             -      -     ____

Sex: (F=Female, M=Male)   ____________________

Citizenship:      What is the nation of your citizenship? _______________________

College or High School Name:

College or High School City/State:

Your Graduation Date:                                          (mm/dd/yyyy)

List in order, beginning with the earliest, all the colleges or universities you have attended, or are now
attending, or plan to attend before entering Trinity College On-Line.

           Name of College                                          Attendance Dates           Degrees You Have Earned or Plan
            or University                Location                    (mm/dd/yyyy)              To Earn Before Attending Trinity

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Have you previously applied to Trinity for admissions?                         (Y=Yes, N=No)        If yes, when?

Have you ever started or completed readings at Trinity?                         (Y=Yes, N=No)         If yes, when?

Have you ever been convicted of a criminal offense other than a traffic violation, or have you been found to be
delinquent by a juvenile court, or are there any such charges currently pending against you? (Y=Yes, N=No)
If yes, please mail a written explanation to the address listed below.

Please indicate how you learned about Trinity College On-Line.

An official high school and/or college record/transcript is required in order to complete the application process.

I hereby submit this application for induction into the College of Fellows. The information contained in this
application is true and accurate. By applying for identification as a Fellow, I agree, if I am inducted into the
College of Fellows, to serve my community by teaching literacy, sharing my appreciation for The Great
Books of the Western Tradition wherever possible; to respond when called upon by the Chair of the
College; and to perform any tasks that are clearly intended to advance the state of academia on behalf of
the College of Fellows and Trinity College.

Must be sent from your email address listed with the Registrar to make this an official signature


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