Salter College
645 Shawinigan Drive
Chicopee, MA 01020
413-206-0300 | Get Directions

184 West Boylston Street
West Boylston, MA 01583
774-261-1500 | Get Directions


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Personal Information
First Name*:
Last Name*:
Middle In:
Street Address*:
ZIP/Postal Code*:
Date of Birth*:
Are you a citizen of the United States?*:
Yes No Permanent Resident
If you are not a U.S. Citizen-Country of Birth:
I am applying as*:

Academic Areas of Study
Preferred Location:
Program of Interest:

Education Information
Freshman: Please list every high school you have attended.
Transfers: Please also note the college in which you are currently enrolled and all others attended.

Name of High School
or College
State Dates of Attendance
Month and Year
Expected date
of graduation
Counselor's Name: Counselor's Telephone #: GPA:

SAT I Scores: Math
List Dates:
Critical Reading
List Dates:
List Dates:
ACT Scores Comp.
List Dates:
List Dates:

Honors Activities

Please list any co-curricular activities in the past four years. Include specific events and/or major accomplishments, such
as musical instruments played, varsity letters, honors, awards, and prizes you have received.

Activity Number of years
of participation
Positions held or
honors won
Continued in college?
Yes No
Yes No
Yes No
Yes No
Yes No

Full- and part-time jobs held

Employer City/Telephone Type of Work Start/End date
of Employment

Signature of Applicant
By electronically transferring this document to Salter College, I certify the above information is complete and correct. I further understand that falsification or failure to supply the correct information may lead to the disqualification of my application for admission to Salter College. I also agree to accept full responsibility for all debts incurred.

I authorize all secondary schools and colleges I have attended to release all requested records and authorize review of my application for the admission process indicated on this form.

By submitting this form, I acknowledge that I am initiating contact with the school and authorize Salter College, part of Premier Education Group, LP to send me calls and texts through an automated telephone dialing system at the phone number or e-mail address provided. I acknowledge that I am not required to consent to receive communications (directly or indirectly), as a condition of receiving information, applying or enrolling at these schools.

Information can also be obtained by calling the school directly. Service charges may be applied by your carrier. You may opt out at anytime.

Salter College admits students of any race, color, national or ethnic origin, physical limitation, religion, age or sexual orientation to all rights, privileges, programs, and activities generally accorded or made available to students at the college. Salter College does not discriminate on the basis of race, color, national or ethnic origin, physical limitation, religion, age or sexual orientation in the administration of its educational policies, admission policies, scholarship and loan programs, and other College-administered programs. The information requested on the application form is for the completion of statistical information only and is not used as a basis for admission.
Thank you for applying to Salter College.