/EarlyDecision2014

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

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