2022 STEM Starter Academy 2-to-4 Summer Transfer Academy Application Form

STEM Starter Academy 2-to-4 year Transfer Academy

Winter 2023
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 UMass Amherst and Fitchburg State University this winter for spring transfer students. You should apply to participate in the program at the institution that you will be attending in Spring 2023; 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 Transfer Academy website to review program dates, program information, deadlines, and contact information for the program that you will be applying to for Winter 2023. 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 Spring 2023 (select multiple if undecided)*

Fitchburg State UniversityUMass Amherst
Have you applied to the University you plan to attend?*

YesNo
Have you been admitted to the University you plan to attend?*

YesNoNot 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?*

YesNoI don't know
Will you have completed an Associate's degree prior to transfer?*

YesNo
Have you participated in any of the following programs? (select all that apply)*

MassTeachTRIOLSAMPNone of the above
Are you a first-generation college student?*

YesNoPrefer not to say
Do you identify as Hispanic or Latinx?

YesNoPrefer not to say
Do you identify as one or more of the following? (select all that apply)

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer not to sayPrefer to self-describe:
Please list the formats you are comfortable participating in this winter (please check all that apply):

In personVirtual
OPEN ENDED RESPONSES

Please respond to at least one of the following open response questions. 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 Winter 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 conditionsI do not agree to these conditions and request that this incomplete form data be deleted.
Electronic Signature*
Type your full name.
Date*

MonthDay Year
Date
Should be Empty:

STEM Starter Academy 2-to-4 year Transfer Academy

APPLICANT INFORMATION

OPEN ENDED RESPONSES

Disclosures