HOMESCHOOL INFORMATION FORM
Part I: To be completed by the applicant
____________________________________________
____________________________________________
First Name
Last Name
_______________________________________
Middle Name
_____________________________________________________________________ ______________________________________________________________
Street Address
________________________________________
City
________________________________________ ________________________________________________
State
Postal Code
Country
___________________________________________________________@______________________________________
Email
__________/_________/___________
Birthdate (MM/DD/YY)
Proof of high school graduation must be submitted by one of the following:



Homeschool final transcript and homeschool diploma
State-certified High School Diploma
GED/TASC/Certificate of High School Equivalency Exam required
Note: NY residents must pass the TASC Exam or an Ability-to-Benefit (ATB) exam to qualify for NY State
Tuition Assistance Program (TAP) funds
□ I understand this graduation requirement and will comply before enrolling. _____________________________________
Student Signature
Part I: To be completed by the homeschool teacher
1.
What factors led to the decision for the applicant to be homeschooled? _________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2.
Is the applicant going to receive a state-recognized high school diploma? If no, successful passing
score on the GED or other certified high school equivalency exam is required before enrolling.
□ Yes
□ No
3.
What curriculum was used? ___________________________________________________________
__________________________________________________________________________________
4.
Were grades given? □ Yes □ No If yes, what grading system was used? ____________________
__________________________________________________________________________________
5.
Please include any additional comments or information which will increase our understanding of the
homeschool instruction. (use the back of the page if needed) _________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
________________________________________
Homeschool Instructor Signature
______________________________________ _____/____/_____ _____________________________
Print Name
Please send this form along with the homeschool transcript to:
Marymount Manhattan College
Office of Admission
221 East 71st Street
New York, NY 10021
Date
Relationship to Applicant