Southbridge Campus New Student Orientation 2021 Registration Form
Class of 2021, we are so excited to welcome you to the QCC campus and community!

At New Student Orientation you will spend the day meeting other members of the incoming class of 2021, current QCC students, and many community members who are resources for you to be successful.

The New Student Orientation Registration Form is mandatory for all new students. The information you provide in this form will help us prepare for your arrival.

If you have any questions about New Student Orientation, email Director of Student Life & Leadership, Ashlee Givins at agivins@qcc.mass.edu.

All students must submit this form by 5pm EDT on Friday, August 13, 2021.
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First Name *
Last Name *
Your Gender Pronouns *
Pronouns are a form of self-expression and self-identification related to gender. For example, "I’m Yoshi, and I use he/him pronouns." Note that some people are referred to by multiple different sets of pronouns, such as she or they. Select all that apply.
QCC Email Address *
If you do not know your QCC email address, please write "N/A".
Personal Email Address *
Cell Phone Number *
Use the following format only, e.g. 617-253-6772. If you don't have a cell phone, please write "N/A”
A Student Life staff member will text you prior to your orientation date. Please check below to confirm we can contact you via text. *
New Student Orientation Date *
Required
COVID Vaccination - Students
COVID Vaccines (Pfizer or Moderna) will be offered at New Student Orientation. Please indicate if you'd like to receive the vaccine at orientation. All students who receive their first or second shot during orientation will be entered into a raffle for a pair of AirPods or Google Pixel Buds.
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COVID Vaccination - Family Members *
COVID Vaccines (Pfizer or Moderna) will also be offered to family members at Orientation. Please select how many family members would like to get the vaccine.
Required
T-shirt Size *
T-shirts are adult unisex sizes. XS is not available.
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