Merrimack Fast Track Application

Personal Information

First Name*

Last Name*

Birthdate*

Gender*

Citizenship Status*

HIDDEN: Set U.S. citizenship

What is your country of birth?*

List of Countries of Citizenship*

Are you Hispanic? (optional)

Ethnicity Race (optional)

Setting the Permanent Resident Field to (Yes) when they select Permanent Resident
On the Citizenship Status Select List.

Yes

No

First Language*

Number of years in the US*

Number of years outside the US*

Permanent Home Address

Permanent Address*

Country

Street

City

Region

Postal Code

Contact Information

Email Address*

Home Phone

Mobile Phone

Clicking the "Submit" button below constitutes your written consent to be called and/or texted by Merrimack or Merrimack's agent at the number(s) you provided, regarding furthering your education. You understand that these calls may be generated using an automated technology.

Admission Information

Application Entry Term*

Applicant Type*

Admission Plan*

Admission Plan* (transfer/hidden)

How many schools have you applied to*?

Are you currently a community college student?*

Are you a member of Phi Theta Kappa?*

Hidden: Set PTK eligible

Have you received grades for at least 24 college credits at your college? (AP, IB, and Dual Enrollment classes do not count toward this total.)*

How many college credits have you received grades for? (AP, IB, Dual Enrollment, and in-progress classes do not count toward this total.)*

Current US Military Status

Intended Major*

Please select an education concentration*

Please select an humanities concentration*

Please select a Management concentration.*

Please select a content major*

Which of the following extracurricular or academic experiences are most important to you in the college experience? (check all that apply)

Housing Status*

Do you intend to apply for financial aid?*

Have you ever been found responsible for a disciplinary violation that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion.*

Please give the approximate date(s) of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Have you ever been convicted of a misdemeanor or felony?*

Please provide the details on your criminal conviction or adjudication and reflect on what you learned from the experience.*

School Information

What school do you currently attend? (Please select from the drop-down menu)*

School CEEB Code

What is your cumulative GPA?*

School start date*

Anticipated graduation date*

Set the School Level (High School)

Set the School Level (Transfer)

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Merrimack Fast Track Application