Application for the SPRINGFIELD CLEMENTE COURSE in the HUMANITIES, 2021-2022
Welcome! Thank you for considering the Clemente Course to further your education. Please fill out this application to the best of your ability. If you have questions, please contact Brenda Hill, the Clemente Course Site Coordinator, at TheClementeCourseSpringfield@gmail.com.
Be sure to complete the personal statement in the space provided or email your personal statement to the address above.

Applicants will be contacted for an interview in August and the deadline for consideration is August 1, 2021.

*Please note, this course may be fully remote in the 2021-2022 academic year, but any and all in-person classes or events will require all those that are eligible to be fully vaccinated for COVID-19 and adherence to Commonwealth health guidelines.

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Personal Information
First Name *
Last Name *
Email Address *
Date of Birth *
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Gender *
Primary phone number *
Home address *
City *
Zip code *
Mailing Address, if different
Emergency Contact Name and Phone Number
Ethnic or Racial Heritage *
First Language *
Are you fully vaccinated against COVID-19 *
Education
Are you currently in school?
Clear selection
If so, where?
Did you graduate from high school? If so, when and name of high school
Are you a GED/HiSET recipient? If so, date of completion/expected completion
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Have you ever attended college? If so, where and years enrolled
Have you earned college credits? If so, how many?
Why did you leave college?
Family
Marital Status *
Do you have children? If so, what are their ages? Do they live with you?
What is your annual household income before taxes? *
Work
Skills/Occupation
Employment Status
Clear selection
Are you currently in a training program? If so, specify
Support
If classes are in person, will you need childcare? *
If classes are in person, will you need transportation assistance? *
If classes are remote (online) you will need access to some type of computer or tablet with a camera and microphone and a reliable internet connection. If you are accepted into the course but don't have the equipment and/or internet access necessary to participate in the online sessions, Mass Humanities and Clemente Springfield will work with you to secure what you need.  Need will NOT impact acceptance into the course. *
Internet Access *
If you currently have an internet subscription, please give us the name of your provider.
Personal Statement
Please respond to these questions in as much detail as possible:
What do you hope to learn or achieve by returning to school and taking college-level courses? *
What will you need to do to accomplish these goals? Discuss the challenges you expect to face. *
Describe your plans for the future, and anything else you would like to share with us. *
This course may run remotely, hybrid, or fully in person. Please note your preference and your reasoning. *
Your application will not be complete until you click on the "SUBMIT" button below.
*The Clemente Course and Bard College do not discriminate in education, employment, admission, or services on the basis of sex, sexual orientation, race, color, religion, national origin, or ability.
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