Spring Pre-College Program Application - Department for Lifelong Learning

Applicant Name*

First Last

Date of Birth*

MM

DD

YYYY

Gender*

Male
Female

Home Phone Number

Cell Phone Number*

Email Address*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Legal Guardian Name*

Prefix First Last Suffix

Home Address (if different from applicant)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please indicate primary phone number.*

Home
Cell
Work

Home Phone Number*

Cell Phone Number*

Work Phone Number*

Parent/Guardian Email Address*

College Advisor Recommendation Form*

Included
Mailed Separately

The College Advisor Recommendation Form confirms applicant's GPA and must be submitted with all applications. Applicants may upload scanned and signed letter below or mail separately.
Mail letters to:
Wagner College Department for Lifelong Learning
Pre-College Program
One Campus Rd., Staten Island, NY 10301

Name of High School most recently attended*

Start Date*

mm/yyyy

Expected Graduation Date*

MM

DD

YYYY

Grade (Fall 2022)*

Sophomore
Junior
Senior

GPA*

School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Guidance Counselor

First Last

Email Address

Phone Number*

How did you hear about this program?*

Email from Wagner College
Wagner Website
Current Wagner Student/Staff
HS Guidance Counselor
Friend/Family
Internet Search
Other

Applicant Signature*

By signing above I certify that all of the information submitted in this application is accurate, and that I have discussed my applying for this program with my parent/guardian.

Parent Signature*

By signing above I certify that I have reviewed the information submitted for accuracy and acknowledge my child's application to the Wagner College Pre-College Program.