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Summer Bridge Academy Application

Instructions:

Applications must be filled out completely and will not be considered until all required forms are received.

Application InformationSave Progress

Last
First
Middle Name

Date of Birth mm/dd/yyyy

Social Security Number xxx-xx-xxxx

Place of BirthSave Progress

City of Birth
State/Province/County

Citizenship StatusSave Progress

Are you a United States citizen?

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

Other

International Student: VISA Type

Primary Mailing Address and Contact InformationSave Progress

Number
Street
Apt. No.

City
State
Zip

Home Telephone No.

Cell Telephone No.

Email Address

BackgroundSave Progress

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

EducationSave Progress

Did you have an Individual Educational Plan?

Yes
No
Unsure

If yes please provide details on the plan.

High School

Counselor Name

Expected Graduation Date

QPA or Cumulative GPA

SAT/TOFL/PSAT/ACT Score

Rank (if available)

Please list any AP/Honors classes you have taken.

Please list all Universities and Colleges to which you have applied and/or accepted.

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.)

Father

Mother

Guardian

Parent/Guardian occupation

List honors/awards received.

List extracurricular activities.

List any leadership positions you held in school or in the community.

Optional: Save Progress

By providing an email address and password here, you will be able to come back at a later time to continue your application.

Passwords must be between 8 and 15 characters long. Please include at least one of each of the following: uppercase letter, lowercase letter, number.

The State of Connecticut and the University 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 University. Students are responsible for providing the University with evidence of their immunity and health status upon matriculation.