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Undergraduate Admission Information Request





 

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Name & Address Information


Please remember to use upper and lower case characters throughout this form.

*  Legal First Name:

Middle Initial:

*  Last or Family Name:

Suffix:

Is this a U.S. address? Yes   No

*  Street Address 1:

Street Address 2:

(if needed)

*  City:

*  State:

*  Zip/Postal:

(U.S. and Canada only)

*  Country:

(if not U.S.)

Home Phone (US only)

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If this is a temporary address,
when will you be leaving?

/ /

(mm/dd/yyyy)

*  Email Address:

*  Re-enter Email Address:

Personal Information


*  Date of Birth:

/ / (mm/dd/yyyy - e.g., 02/27/1975)

*  Gender:

Male  Female

Academic Information


*   Freshman Transfer

*  Planned Enrollment Term at UMass:

Fall (September) Spring (January)

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