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Summer Bridge Academy Application

Instructions:

Application InformationSave Progress

Place of BirthSave Progress

Citizenship StatusSave Progress

Are you a United States citizen?

Are you a Permanent Resident of USA? ( I-9 card )

Primary Mailing Address and Contact InformationSave Progress

BackgroundSave Progress

Racial/Ethnic Background of student (please check all that apply)

EducationSave Progress

Did you have an Individual Educational Plan?

Are you the first in your immediate family to attend college?

Parent/Guardian InformationSave Progress

Parent(s)/Guardian highest level of education (GED, High School Diploma, Associates, Bachelors, Masters, Ph.D./Ed.D.)

Optional: Save Progress

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The State of Connecticut and the College mandates that students born on or after January 1, 1957, must submit evidence of immunization against mumps, measles, and rubella in compliance with the Connecticut State Law Public Act 89-90 unless proof of a medical or religious contraindication is submitted. All students born on or after January 1, 1980, must provide proof of adequate immunization against varicella (chicken pox). Adequate immunization for mumps, measles, rubella, and varicella consists of two doses of vaccine separated by at least 28 days with dose number one given on or after the first birthday.

NOTICE:All Students must be in compliance with health clearance policies as required by Goodwin College. Students are responsible for providing the College with evidence of their immunity and health status upon matriculation.