Application Type * Fall (August) 2020 Spring (January) 2020 First Year Transfer Full-time Part-time Resident Commuter Personal Information Last * First * Middle Preferred Name Address & Contact Info Number * Street * Apartment Number City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code * Email Address * Telephone Cell Phone Birthdate & Birthplace Birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 City * State/Country * Citizenship * United States Other Country Visa Type Native Language Language Spoken at Home Social Security Number Gender * Male Female Friends/Family AttendedPlease indicate any friends or relatives who attended Chestnut Hill College. Name Relationship Class/Year Name Relationship Class/Year Do you intend to apply for financial aid? * Yes No SAGE scholar? * Yes No Emergency Contact Name * Relationship * Phone * Email Address Chestnut Hill College is required by the federal government to ask the following questions about your race/ethnicity. Your responses enable us to do research, as well as qualify for grants and develop programs that will benefit our students. This information will never be used in decisions about individuals, such as admissions or registration or employment priorities. It will be used only for research, grant applications, and efforts to improve our academic programs and student services. We ask that you please respond to both of the following questions as accurately as you can. Please select ALL of the following that apply to you: Race Hispanic or Latino or of Spanish origin Not Hispanic or Latino or of Spanish origin American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Education Please list high school(s) attended: Name of High School HS City HS State Dates Attended Graduation Date GPA SAT Score Critical Reading and Writing Math Total (CRW + M) ACT Composite Type of High School Private Public Parochial Home-schooled Guidance/Academic Counselor Salutation Mr. Mrs. Name Phone Intended Major Please list any sports, activities, honors, special achievements or employment: Athletics Select the sport(s) you with to participate Baseball Basketball Cross-country Golf Lacrosse Soccer Softball Tennis Track Volleyball Sprint Football How did you hear about Chestnut Hill College? Radio Mail College Fair Newspaper Internet Guidance Office Alumni TV Other How did you hear about Chestnut Hill College? Other Other Required Information Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from ninth grade forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution? Disciplinary Violation * Yes No Have you ever been convicted of a misdemeanor, felony or other crime, or do you have any such charges pending? Conviction * Yes No If you answered yes to either or both questions, please attach a separate sheet with information regarding the incident(s), including date(s) and explanation(s) of the circumstances. Depending on the above responses, the College reserves the right to request additional information and/or require a criminal background check at the applicant’s expense. All Applicants Chestnut Hill College is committed to providing equal educational opportunities for qualified students in keeping with their career and professional goals. In all of its policies and operations, the College complies with applicable federal and state laws. Before undertaking a field of study, students are responsible to learn eligibility requirements and issues related to licensure and/or employment in their field of interest (such as satisfactory GPA, course requirements, criminal background checks, professional licensure and certification requirements, internship requirements, etc.). Chestnut Hill College reserves the right to refuse admission or require the withdrawal of admission for any reason deemed sufficient to the College. Denial of admission to the School of Undergraduate Studies may be deemed denial of admission to the School of Continuing and Professional Studies. I affirm that all information in my application is complete, factually correct and honestly presented. I grant Chestnut Hill College permission to act as my representative in obtaining transcripts/educational records. I understand that withholding information or the submission of false or misleading information will make me ineligible for admission to the College or subject to dismissal. Signature * Signature By checking this box I affirm all information is correct to the best of my knowledge. Leave this field blank
