Fellow Application (DOC)

							                          Trinity College – email to Trinityonline@walla.com
  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
                                                                              Initial

Date of Birth     __________________Email Address __________________________________
                 _________________

Address:
                  Street/Apt. No.


                   City                    State/      Zip/Postal        Country
                                           Province    Code


Phone Number
                             -      -      ____
Home:


Phone Number
                             -      -     ____
Work:

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?
(mm/dd/yyyy)


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


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.


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



________________
DATE




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