1. education
2. graduate school
3. college

Application for enrollment
Please print clearly in English and in BLOCK letters and return your application to your local representative or email to [email protected]
Please tick boxes where appropriate. Please note all sections are compulsory. We are unable to process an application unless we have full details of the student
applying for the program.
Local representative information
Representative name
Branch
Email
URN
Student details
Family name(s) (as appears in passport)
Given name(s) (as appears in passport)
Title
Age
Date of birth (mm/dd/yyyy)
Country of birth
Gender: M
F
First language
Country of Citizenship/Nationality
Home address (including city)
Country
City/Postcode
Current address (if different from home address)
Email
Home telephone number (including country code)
Mobile telephone number (including country code)
Do you have a spouse and/or children that will be accompanying you to the USA as of the date you will begin classes at the university? Yes
No
(please tick)
Do you currently hold a valid I-20 from another U.S. school? Yes
No
(please tick) If Yes, please attach a copy of your current I-20, visa and I-94 card.
You also need to complete the Merrimack College I-20 SEVIS Transfer Form.
Are you currently in the U.S. on another non-immigrant visa (examples: B-1/B-2, F-2, etc.)? Yes
If Yes, please attach a copy of your current non-immigrant visa.
No
(please tick)
Intended start
When would you like to start? August
January
May
(please tick)
Intended degree program
Refer to Appendix for Merrimack College degree options.
University degree program (e.g. Management) (required)
Application checklist and required documentation:
Complete and accurate application form including intended degree program, email address and telephone number
Scanned, certified, full transcripts of all your academic qualifications in native language and translated into English with the translation authenticated
A
scanned copy of official test scores from an English Language Test such as IELTS, TOEFL iBT or the free Password Test
Resume/CV
A copy of the identification pages of your passport
A copy of your current I-20 and visa, if applicable
A scanned copy of a certified bank statement (within 3 months) translated in English indicating sufficient funds including amount available
Original, sealed academic transcripts and credential completion document MUST be submitted prior to or upon arrival at Merrimack College.
Official records may be sent to Merrimack College directly by the previous institution prior to orientation.
MERR-APP-I
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Previous education
Please give details of all the secondary school, college, university, and English language schools you have attended. Please include full, scanned, certified transcripts
of all your academic qualifications, translated into English along with translation authenticated by a notary public or similar official.
Institution name (include city and country) Date attended (mm/yyyy)Subject/major
From
To
From
To
From
To
From
To
From
To
Grades/results
Standardized testing
Please enclose copies of your test score reports, if applicable. Original copies are required to start classes.
IELTS (score)
TOEFL iBT (score)
Password (score)
Pearson (score)
GRE / GMAT (score)
Embassy English (level)
Primary language of instruction
What is your Undergraduate primary language of instruction?
Additional information
Payment of tuition fees
Self
Parent/guardian
Company sponsor
Government sponsor
(please tick)
Please give full name of sponsor
Accommodation
Students in the Pre-Master’s Program live in Merrimack campus housing and have a minimum of a 5 meal per week dining plan. This housing is apartment-style with
4-6 students living in each unit. The units are furnished, have kitchens and are supported by designated staff and services. You will be sent information on housing
arrangements upon offer of admission. In the unlikely event campus housing becomes unavailable, staff at the ISC will help students book off-campus housing. It is
important to note that off-campus housing options are very limited, likely unfurnished and may require a car, so we recommend you confirm early to ensure a space
in the on-campus residences. If you have a special situation that you feel may require off-campus housing, please provide additional information here.
Student insurance
The Commonwealth of Massachusetts mandates that all students be covered by health insurance. To ensure compliance, Merrimack students are automatically
enrolled in a compliant health insurance plan. You may be eligible to waive this insurance if you have alternative adequate coverage.
For full details, visit www.merrimack.edu/admission/tuition/student-health-insurance.php
Will you require Merrimack College health insurance? Yes
No
(please tick)
no, you will be required to complete a waiver if you are admitted, after confirming your place.
If
Criminal and disciplinary record
Other than traffic violations, have you ever been convicted of a misdemeanor, felony or other crime? Yes
No
(please tick)
Have you ever been charged, suspended, removed, dismissed or expelled from any educational institution for academic or disciplinary reasons? Yes
No
(please tick)
If you answered yes to either of the above, submit a separate, full, signed statement of relevant facts.
How did you hear about us? Choose one of the following:
Agent
Educational Fair
Website
Friend/relative recommendation
Other (please specify)
Please turn to page 3 to sign the declaration
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Confirmation procedure
Once we receive your completed application it will be evaluated for admission and a decision will be issued within 2-5 working days. If admitted, you will receive an offer of
admission which needs to be confirmed by paying the deposit. The university will then issue the I-20 and you will receive pre-arrival details featuring further instructions.
Declaration
Acceptance – by the student
I apply to enroll the person named as a student of Merrimack College. I undertake to pay all tuition and accommodation fees incurred by the student as
they become due in accordance with the Terms and Conditions and, where relevant, either to give the required notice of cancellation or to pay the required fees
in lieu of notice.
By ticking this box I confirm the following:
• I am the student, or have the full and express authority and consent of the student to submit this application on their behalf.
• All information submitted in the admission process – including this application and any other supporting materials – is complete, factually true and honestly presented.
• I understand that I may be subject to a range of possible disciplinary actions should the information I have confirmed above be false.
Full name (signatory)
Date (mm/dd/yyyy)
Any Offer will be made subject to acceptance of our terms and conditions.
The current terms and conditions can be viewed at isc.merrimack.edu/terms-and-conditions
Merrimack College, 315 Turnpike Street, North Andover, MA 01845
20165_PEGA 04/15
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Appendix
Resume/CV
Applicant’s resume or CV should contain a summary of education, training, and
paid and unpaid experience. You may also include relevant research or project
descriptions, software skills, activities, awards, and interests.
Merrimack College Pre-Master’s Program Degrees
Progression Degree
Degree Designation
Management
Accounting
Civil Engineering
Mechanical Engineering
MS
MS
MS
MS
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