The Bard College Clemente Course in the Humanities At Elm Park Community School, Worcester, ma
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| The Bard College Clemente Course in the Humanities
At Elm Park Community School, Worcester, MA Hosted by Worcester Interfaith Application for Admission To apply: 1) Call Elizabeth Bacon at 774-276-1166 to schedule an interview. All interviews will take place at Worcester Interfaith, 111 Park Ave., Worcester, MA 01609 (First Baptist Church) 2) Please fill out this application completely and bring it with you to the interview. Personal Information Legal name______________________________________________________________________________________ Date of birth ______________________________________Sex _________________ month/day/year M/F Home address _______________________________________________________________________________________ Number and street, Apt. # city state zip code Mailing Address (if different)___________________________________________________________________________ Home phone ________________________ Work/other phone_______________________ e-mail____________________ In emergency contact _________________________________________________________________________________ Name Phone Ethnic or racial heritage (optional) _______________________________First language____________________________ U.S. Citizen __________ Permanent resident __________ Other status (please specify)____________________________ Entitlements (SSI, WIC, TANF, AFDC etc.) ______________________________________________________________ Education Highest grade completed __________Are you currently in school?___________ Where?____________________________ Did you graduate from high school? __________ When?__________ Name of School______________________________ Are you a GED recipient? _______ Date of GED completion _______Are you currently working toward a GED? ________ Have you ever attended college?_________ Where? _________________________________For how long? ___________ Have you earned college credits? ________ How many? __________________ Why did you leave college? ____________ ___________________________________________________________________________________________________ Family/ Household Marital status: ◊ single ◊ married ◊ separated ◊ divorced ◊ widowed Do you have children? ____________ If yes, what are their ages? __________________ Do they live with you?_________ With whom do you live? ◊ alone ◊ with parents ◊ with spouse or companion ◊ with siblings ◊ with friends ◊ other arrangement (please specify) _____________________________________________________________________ (OVER)
What is you annual household income (before taxes)? ◊ under $1,000 ◊ $1,000 - $5,000 ◊ $5,000 - $10,000 ◊ $10,001 - $15,000 ◊ $15,001 - $20,000 ◊ $20,001 - $25,000 ◊ $25,001 -$30,000 ◊ Over $30,000 Employment/Training Skill/occupation _____________________________________________________________________________________ ◊ employed full time ◊ employed part-time ◊ unemployed ◊ intern ◊ volunteer Are you currently in a training program? (please specify)_____________________________________________________ What other jobs/training have you had? ___________________________________________________________________ Are you enrolled in other programs (please specify: recovery, therapy, etc.)_______________________________________ Childcare/Transportation Will you need childcare to attend these classes? If yes, please specify ages of children______________________________ Will you need bus fare to attend classes? _________ If yes, describe cost per class: ________________________________ ___________________________________________________________________________________________________ Personal Statement In the space below, write a statement describing yourself, your interests, your reasons for wanting to take this course and your plans for the future. (c 250 words or more) Bard College does not discriminate in education, employment, admission, or services on the basis of sex, sexual orientation, race, color, religion, national origin, or handicapping conditions. Directory: wp-content -> uploads -> 2014 2014 -> For want of a nail 2014 -> Stop Militarizing Law Enforcement Act of 2014 2014 -> Ihbb asian Championships 2014 middle school bowl Round 4 First Quarter 2014 -> Ihbb european Championships 2014 Bowl Round 4 First Quarter 2014 -> International History Bee and Bowl 2013-14 Asian Division Question Set Bowl Round Six 2014 -> United states patent and trademark office 2014 -> Coffs harbour eisteddfod vocal syllabus 2014 -> Listen News Programs Schedule pledge now 2014 -> Slow club announce third album complete surrender Download 16.54 Kb. Share with your friends:
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