OFFICE OF GRADUATE STUDIES
300 Summit Street
Hartford, CT 06106-3100
Telephone: (860) 297-2527
Fax: (860) 297-2529
e-mail: grad_studies@mail.trincoll.edu

NON-MATRICULATED GRADUATE APPLICATION

Term/Year of desired enrollment:
Fall     : 19 _____
Spring   : 19 _____
Summer : 19 _____

Name:__________________________________________________________________
(Last name first - please print all information)

Social Security #:______ -______ - ______ Previous name, if applicable: ________________________________________________

Permanent Address ________________________________________________________________

Work Address ________________________________________________________________

Telephone Home:______________________ Work:___________________________________

Do you plan to apply for the Master's degree at Trinity after successfully completing two (2) graduate credits?_________ If yes, when? __________________

To which program?____________________________________________

Your application for non-matriculated/special Graduate study at Trinity College must be accompanied by an official copy of your undergraduate transcript--indicating receipt of the Bachelor's degree--and by any other appropriate academic record.

Please note that your registration for the coming semester cannot be processed until all of your application materials have been received and approved. In addition to an official copy of your undergraduate (Bachelor's degree) transcript, this application must also be accompanied by your full tuition payment, the appropriate fees, and your completed Registration form.

I. Directory Information Release Code: ______ (see below)
   (This information is not applicable to Summer Enrollment)

You have the right to withhold your name and any or all directory information (e.g. home address) from the NEXT publication of the Trinity College Directory for faculty, staff, and students (the current directory has already been published based on release information received previously).  Please indicate on the line above how you would like to appear in the next directory.  NOTE: If you choose to withhold all information, even your name will not appear.

            Directory Information Release Codes:
            Blank -  (by leaving the above line blank, you are giving your permission to release all information in the next directory).
            A         -  Do not release home address in the next directory.
            D          -  Do not release any information in the next directory.  (NOTE: All information, including your name, will be withheld if you
                            select this option).
            H          -  Do not release any home information.
            P           -  Do not release home telephone.

II.  Emergency Information - Name of Person to Notify

                            Name: ________________________________             Relationship: ___________________

                            Telephone:         (Home): _______________________        (Work): ____________________

III.  Other Important Information:

Please use the appropriate  codes (see below) to complete the following information:

Birthdate: _______________________                                                                 Sex: ______________________
Citizenship: _____________________                                                                  Marital Status: ______________
If Foreign, Visa Type: ______________                                                                 Handicap Type: ______________
Expiration Date: __________________                                                                  Veterans Code: ______________
Ethnic Origin: ____________________                                                                Veterans Benefit: ____________

                    Ethnic Origin:                                                                       Veterans Code:
                    1 - Asian or Pacific Islander                                                Blank     - Non-Veteran
                    2 - Black (Not of Hispanic Origin)                                      VN         - Veteran not eligible for benefits
                    3 - American Indian or Alaskan Native                             VE          - Veteran eligible for benefits
                    4 - Hispanic                                                                            DP         - Dependent of deceased war veteran
                    5 - White (Not of Hispanic origin)                                      VR         - Vocational rehabilitation
                                                                                                                     RE         - Reservist eligible for benefits

                    Sex:
                    F- Female
                    M - Male                                                                                   Handicap Type:
                                                                                                                      Blank     - None
                                                                                                                      1             - Confined to wheelchair
                                                                                                                      2             - Requires crutches
                                                                                                                      3             - Legally blind
                    Marital Status:                                                                        4             - Impaired vision
                    S - Single                                                                                  5            - Totally deaf
                    M - Married                                                                             6             - Impaired hearing
                    T - Other                                                                                   7            - Speech difficulty
                                                                                                                       8            - Emotional Problem
                                                                                                                       9            - Learning difficulty
                                                                                                                      M           - Multiple Handicap

                    Veterans Benefit:
                    30    - Chapter 30
                    32    - Chapter 32
                    35    - Chapter 35
                    06    - Chapter 106