Dean College

Student Information

*Student First Name:

Middle Initial:

*Student Last Name:

*Student Street Address:

Apt #/Unit:

*Student City/Town:

*Student State:

*Student Postal Code:

*Student Home Phone:
(At least one phone # required)

*Student Cell Phone:
(At least one phone # required)

*Current Student Email Address:

*Current High School:

*Last High School Grade Completed:

Social Security Number:

(Required if a US citizen)

*Student Date of Birth:

Race/Ethnicity: (Optional - Collected for statistical reporting purposes only)

Black/Non-Hispanic

Asian/Pacific Islander

Native American

White/Non-Hispanic

Hispanic

*Gender:

Male

Female

Other

*Citizenship:

US	International Student

(Non-US citizen)

*Are you a Permanent Resident?

Yes

No

Student Information

Click here to use student information

*Parent/Guardian Name:

*Address:

Apt #/Unit:

*City:

*State:

*Postal Code:

*Home Phone:
(At least one phone # required)

*Cell Phone:
(At least one phone # required)

*Work Phone:
(At least one phone # required)

*Email:

*Select Program:
Note - Registration is on a first come, first served basis.

*Please confirm that you have or will request a copy of your high school transcript to the address below.:

Yes

No

Please have transcripts sent to:
Dean College
Attention: Lidiana Conner
99 Main Street
Franklin, MA 02038

*Have you applied and/or been accepted to Dean College?:

Yes

No

*How did you hear about the Dean Pre-College Program?:

If you have any academic support or accessibility requests, please list that request here:

Payment Option:

Pay full amount

Pay $500 Deposit Only

Pre-College Registration

Commuter Option:

Session #1: July 20th to July 26th

Session #2: July 27th to August 2nd

Resident Option:

Session #1: July 20th to July 26th

Session #2: July 27th to August 2nd