Trinity College
Hartford, CT 06106
Term Applying For: __________________
Application for New Non-Matriculated Undergraduate Students (please print)
Name: _________________________________________________________________________
Permanent Mailing Address: ________________________________________________________
_________________________________________________________
Local address (if different): _________________________________________________________
_________________________________________________________
E-mail address: ___________________________________________________________________
Phone: Home ______________________ Work __________________ Cell __________________
Have you previously applied to or attended Trinity College? __________ If yes, when?_________
Are you a Trinity employee? ___________ If yes, what department? ________________________
Are you related to a Trinity employee? _______ If yes, name and department __________________
Previous Education (including high school)
Institution
Dates
Degree?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Briefly, why do you wish to enroll at Trinity? ___________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Signature
Date
(over)
Emergency Contact Information: Name _____________________________________________
Relationship _________________________ Telephone __________________________________
Student Information
Social Security Number: _________________________ Birth date: _________________________
Gender: ________________________ Marital Status : ______________________________
Citizenship: _________________ If Foreign, Visa Type/Exp.Date: __________________________
Ethnic Origin (check one)
_____ Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian Subcontinent or the Pacific Islands. This includes people from China,
Japan, Korea, the Philippine Islands, American Samoa, India and Viet Nam.
_____ Black – All persons having origins in any of the black racial groups of Africa (except those of
Hispanic origin).
_____ American Indian or Alaska Native – All persons having origins in any of the original peoples of
North America, and who maintain cultural identification through tribal affiliation or community
recognition.
_____ Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin, regardless of race.
_____ White – All persons having origins in any of the original peoples of Europe, North Africa or the
Middle East (except those of Hispanic origin).
_____ Minority, multicultural - All persons whose ethnic origins can be defined as more than one of the
above categories
Military Description:
_____ Veteran eligible for benefits
_____ Dependent of deceased war veteran
_____ Reservist eligible for benefits
_____ Vocational Rehabilitation
Directory Information
You have the right to withhold your name and any or all directory information (e.g. address, phone
number etc.) from the NEXT publication of the Trinity College Directory. Note: If you choose to
withhold all information, even your name will be withheld.
Please indicate if you would like to have any of the information withheld:
_____ Do not release ANY directory information
_____ Do not release address information
_____ Do not release telephone number(s)