2021 STEM Starter Academy 2-to-4 Summer Transfer Academy Application Form

STEM Starter Academy 2-to-4 Summer Transfer Academy

2021 Application
Congratulations on your decision to continue your studies in STEM! The Massachusetts Department of Higher Education and public colleges and universities have partnered together to support STEM transfer academy programs for students transferring from the community colleges to a Massachusetts 4-year institutions.

Programs are being offered at all of the public 4-year institutions that offer STEM baccalaureate degrees. You should apply to participate in the program at the institution that you will be attending in Fall 2021; if you are uncertain about where you will be attending, please select the universities you have applied to. Once you have been accepted and determined where you will be going, let us know so we can have you enroll in the appropriate program.

Please refer to the Summer Transfer Academy website to review program dates, program information, deadlines, and contact information for the program that you will be applying to for Summer 2021. It is your responsibility to make sure that you are sending the application to your program by the deadline listed on the website (note: the deadlines differ by institution).

If you have any questions about completing this form, please contact Allison Little at alittle@dhe.mass.edu
APPLICANT INFORMATION
Name *

First Name Middle Initial Last Name
Institution Affiliated Email *
example@example.com
Personal Email *
example@example.com
Cell Phone *
Community College you last attended *
Community College Student ID *
If don't a Student ID number, put N/A in this field.
University you plan to attend in Fall 2021 (select multiple if undecided) *

Bridgewater State Fitchburg State Framingham State MassMaritime Academy MCLA Salem State UMass Amherst UMass Boston UMass Dartmouth UMass Lowell Westfield State Worcester State
Have you applied to the University you plan to attend? *

Yes No
Have you been admitted to the University you plan to attend? *

Yes No Not Applicable
Major/Program of Study at the Community College *
Intended Major/Program of Study at the University *
Have you previously participated in a STEM Starter Academy Program? *

Yes No I don't know
Will you have completed an Associate's degree prior to transfer? *

Yes No
Have you participated in any of the following programs? (select all that apply) *

MassTeach TRIO LSAMP None of the above
Are you a first-generation college student? *

Yes No Prefer not to say
Do you identify as Hispanic or Latinx?

Yes No Prefer not to say
Do you identify as one or more of the following? (select all that apply)

American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to say Prefer to self-describe:
OPEN ENDED RESPONSES

Each response should be between 100 – 250 words.
What resources were the most helpful to you during your time at community college? (Please write 100 – 250 words) *

0/260
What resources would be most helpful to you while you pursue your bachelor’s degree? (Please write 100 – 250 words) *

0/260
Why do you want to participate in the Summer Transfer Academy? (Please write 100 – 250 words) *

0/260
Disclosures

You must agree to both sets of conditions below in order to submit a STEM Starter Academy Application to the Massachusetts Department of Higher Education using this form.
Confidentiality Statement — Under most circumstances, the text of your application will be considered public records, copies of which are available to any member of the public upon request. However, your name, email address, phone number, and any other information that identifies you will not be disclosed. Furthermore, no part of your application will be provided in response to a request that asks specifically for an application submitted by you.

Authorization & Waiver — By signing and submitting this application, I hereby acknowledge that I am authorizing the Department of Higher Education to transmit this application, to the institution(s) I have selected by using JotForm, for their response and that I am giving the Department of Higher Education the authority to collect, host and share this form data, with the institution(s) I have selected, using JotForm. I waive any and all personal privileges which may attach to such information only to the extent necessary for the proper review of my application by the Department of Higher Education and the institution(s) I have selected.

If you have any questions or concerns, please contact Allison Little at alittle@dhe.mass.edu

If you do not agree, you may close your browser window, and your form data will be discarded; or select “I do not agree” below to delete your application data.
Do you agree to the Confidentiality Statement and the Authorization & Waiver above? *

I agree to these conditions I do not agree to these conditions and request that this incomplete form data be deleted.
Electronic Signature *
Type your full name.
Date *

Month Day Year
Date
Should be Empty:

STEM Starter Academy 2-to-4 Summer Transfer Academy

APPLICANT INFORMATION

OPEN ENDED RESPONSES

Disclosures