QMC Student Interest Form
We're glad you're interested in learning more about the Quinebaug Middle College learning community!
Fill in the form below to get started. Know that all information collected will remain confidential and will be destroyed after the recruitment season. 
If you have questions, reach out to our Administrative Assistant, Neida Rosado at nrosado@eastconn.org 

Thanks, and hope to see you soon!
Sign in to Google to save your progress. Learn more
Student First Name: *
Student Last Name: *
Student's preferred gender pronoun(s)? *
Parent First Name: *
Parent Last Name: *
Parent Email Address: *
Cellphone Number: *
Why do you want your son/daughter to attend QMC? *
Student's Current Grade Level in 2023-2024: *
Scholar's Interested Pathway *
Additional information: *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms