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?*

Are you Hispanic? (optional)

Ethnicity Race (optional)

List of Countries of Citizenship*

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.

School Information

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

School CEEB Code

School Counselor or School Administrator Information

Note: The name and email you provide below will initiate an email to your counselor so they can upload your admission documents.

Counselor / School Official Full Name*

Counselor / School Official Email Address*

What is your cumulative GPA?*

Admission Information

Application Entry Term

Fall 2024

How many schools have you applied to*?

Applicant Type*

Current US Military Status

Intended Major*

Combined Major*

Please select an education concentration*

Please select a business 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.*

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Merrimack Fast Track Application