St. Joseph's University, New York - High School Bridge Program Application

Biographical Data

Program = Bridge

Name

First

Middle

Last

Preferred (if different than first)

Former or Other Last Name

Mailing Address

Home Address

Country

Street

City

Region

Postal Code

Country

Street

City

Region

Postal Code

Contact Information

Home Phone

TTY/TDD (if applicable)

Mobile Phone

Parent/Guardian Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Relationship Type

Demographic Information

Birthdate

Legal Sex

Are you a resident of New York State?

Yes

In which county do you reside?

Citizenship

Are you a permanent resident of the United States?

Yes

Is English your native language?

Yes

What is your primary language?

Race and ethnicity information is not required. Response is voluntary and information is used for statistical purposes only. Confidentiality is maintained.

Are you of Hispanic/Latino descent? (a person of Cuban, Mexican, Puerto Rican, South American, Central American, or other Spanish culture or origin regardless of race)

Yes

Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more)

Admissions Data

Coursework Term

High School

Expected Graduation Date

Expected College Entry Year

Additional Information

Have you ever been found responsible for a disciplinary violation at any educational institution you have attend from the 9th grade forward (high school or college), whether related to academic misconduct or behavioral misconduct that resulted in disciplinary action?

Yes

Please provide a detailed explanation:

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Yes

Please provide a detailed explanation:

Signature

All students: I certify that the information I have provided on this application is accurate and complete to the best of my knowledge. I authorize St. Joseph's University, New York to make reasonable inquiries into the accuracy of the information provided, including a background check. I understand that this application must be complete and that all requested documentation must be submitted before an admissions decision cab be rendered. I further understand that any misrepresentation or omission of requested information may result in admission being rescinded or in dismissal at any time after admission.

In place of your signature, please type your full legal name:

Date

It is the policy of St. Joseph's University, New York not to discriminate on the basis of race, color, religion, sex, national or racial origin, age, handicap, or marital status in its educational programs, admission policies, employment policies, financial aid or other school-administered programs. This policy is implemented in compliance with all applicable federal, state, and local statutes or regulations.

St. Joseph's University, New York - High School Bridge Program Application

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