J anuar y15,2011
Enrollment Form continued
Please provide parent/guardian information. The College will be communicating with your parent/guardian throughout your academic experience. The following information will be used for such communication.
Parent 1/Guardian 1
Parent 2/Guardian 2
Relationship to Student _______________________________
Relationship to Student _______________________________
❑ Dr.
❑ Dr.
❑ Mr.
❑ Mrs. ❑ Ms.
❑ Mr.
❑ Mrs. ❑ Ms.
First Name ________________________________________
First Name ________________________________________
Last Name ________________________________________
Last Name ________________________________________
Street Address (if different from student) ____________________________________________________
Street Address (if different from student) ____________________________________________________
City ________________________________________________
City ________________________________________________
State ________ Zip ___________ Country ________________
State ________ Zip ___________ Country ________________
Home Telephone Number _____________________________
Home Telephone Number _____________________________
Cell Phone __________________________________________
Cell Phone __________________________________________
E-mail ______________________________________________
E-mail ______________________________________________
Name of Employer ___________________________________
Name of Employer ___________________________________
Job Title ____________________________________________
Job Title ____________________________________________
College(s) Attended __________________________________
College(s) Attended __________________________________
Degree(s) and Year of Graduation ____________________________________________________
Degree(s) and Year of Graduation ____________________________________________________
Please list any family members who have attended Emmanuel College. Name
Year of Graduation
Degree or Certificate
Relationship to You
_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________
Please sign and return this form with payment to the address below. Contact the Office of Admissions at 617.735.9715 or enroll@emmanuel.edu with any questions.
Office of Admissions, Emmanuel College, 400 The Fenway, Boston, MA 02115
EC4