Mercy College
School of Education
Mathematics Education Intensive Residency Program (MEIRPro)
For United States Military Veterans
Pre-registration Form
(Please type or print all information)
Student Name: ____________________________________________________________________________
LAST
FIRST
Branch of Military Service_______________________________________________________
Years of Service__________________________________
Undergraduate Institution_________________________________________________________________
Home Telephone # ___________________________Mobile #_____________________________________
Home Address _____________________________________________________________________________
_____________________________________________________________________________
Email Address _____________________________________________________________________________
Academic Reference ____________________________________________________________________
***Follow-up information regarding applications and registration will be emailed to you***
For more information, please contact:
Professor William Farber, Program Director
Email: [email protected]
Office: (914) 674-7675