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Undergraduate Admission Information Request


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Name & Address Information

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*  Legal First Name:

Middle Initial:

*  Last or Family Name:


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Street Address 2:

(if needed)

*  City:

*  State:

*  Zip/Postal:

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*  Country:

(if not U.S.)

Home Phone (US only)

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

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Personal Information

*  Date of Birth:

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

*  Gender:

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Academic Information

*   Freshman Transfer

*  Planned Enrollment Term at UMass:

Fall (September) Spring (January)

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