Hartwick-Application

Application

Please complete the form below to submit your Hartwick Summer College application. Note: additional documentation must be submitted along with your application. Read How to Apply for complete instructions.

*A red asterisk indicates that the entry is required.

*First name:
*Last name:
*Date of birth:	MM / DD / YYYY
*Gender:	Male Female
*Social Security Number:
The student's Social Security Number is required by federal regulations for completion of tax reporting form 1098-T.
Home Address:
*Street address, P.O. box, c/o
Apartment, suite, unit, building, floor, etc.
*City:
*State: (USA, US territories, and Canada only)
ZIP/Postal code:
Country:
*E-mail address:
*Home phone, with area code:
Cell phone, with area code:
High School:
High school name:
High school street address:
High school city:
High school State: (USA, US territories, and Canada only)
High school ZIP/Postal Code:
High school Country:
Expected graduation date (MM/DD/YYYY):
Parent or Guardian:
*Parent/Guardian first name:
*Parent/Guardian last name:
Parent/Guardian e-mail address:
Parent/guardian home phone, with area code:
Parent/guardian cell phone, with area code:
Parent/Guardian address, if different from yours:
Street address, P.O. box, c/o
Apartment, suite, unit, building, floor, etc.
City:
State: (USA, US territories, and Canada only)
ZIP/Postal code:
Country:

*How did you hear about Summer College (e.g. radio, magazine,school visit, e-mail, etc.)

The following information that you provide will not be used in a discriminatory manner:
Are you a US Citizen? Yes No
What is your ethnic background?

Please enter 1, 2, and 3 in front of your first, second, and third choice courses:
MUSI 150 The Dynamics of Music
ART 250 Introduction to Animation & Video
BIOL 150 Topics in Biology: Research in Biology
THEA 150 Performance Workshop
ENGL 213 Intro to Creative Writing

I certify that all information submitted in the application process, including all the supporting materials, is my own work, factually true, and honestly presented. I understand that I may be subject to revocation of summer college, should the information which I have certified be false.

Student Signature: (type your name)

Be sure to submit your essay if providing one, high school transcript, and parent form in a timely manner.