First Name*
required*
Last Name*

Address 1*

Address 2

City*

State/Province

Zip/Postal Code*

Country*

Home Phone*

Cell Phone

Email*

How would you like us to contact you?
 Home Phone  Cell Phone  Email

Gender:
 Male  Female

Are you currently enrolled in school?
 Yes, please specify school
 No, please specify last school attended:

What best describes you?
(Click here to choose) I have a high school degree and no college credit I have a high school degree and some college credit I have an Associates degree I have a Bachelors degree I have a Masters degree

What programs are you interested in? Please select all that apply.

Graduate Programs in Education (MS)
Education Preparation (1-6)
Curriculum & Instruction
Literacy
Special Education
Canadian Teacher Education Program

Graduate Program in Mental Health Counseling (MA)
Mental Health Counseling

Graduate Program in Psychology (MA)
Psychology

Accelerated Learning Programs
Associate of Science in Business (AS in Business)
Bachelor of Business Administration (BBA)
Master of Business Administration (MBA)
Master of Arts in Organizational Leadership (MOL)

I have not decided on a program of study yet.

I am interested in taking ALP classes at the
Amherst Campus
Rochester Campus
BBA at Finger Lakes Community College

How did you hear about us?
(Click here to choose) Newspaper Ad Radio Ad Postcard or other mailing Friend or Family Employer Other

Intended start date:
(Click here to choose) Summer 2008Fall 2008Spring 2009Summer 2009Fall 2009July 2008 (Accelerated Learning Program)September 2008 (Accelerated Learning Program)November 2008 (Accelerated Learning Program)January 2009 (Accelerated Learning Program)March 2009 (Accelerated Learning Program)May 2009 (Accelerated Learning Program)

Medaille College does not sell, rent or share any personal data submitted by visitors to this Web site to any third parties. Medaille College respects the privacy of users visiting this Web site and will abide by all applicable laws concerning the release of personal information.

If you have questions about our Accelerated Business Programs or Professional Certificates Email our Admissions office jmatheny@medaille.edu or call 1-888-252-2235.

If you have questions about our Education and Mental Health or Psychology Programs Email our Admissions office gradadmissions@medaille.edu or call 1-800-957-5033.