Mosaic 2024 Student Application

We are so excited that you’re interested in applying to Mosaic 2024! Before you get started please review the items you need to complete the application. You will not be able to save and return to this form:

✅ A few short answer questions and one extended response about your interests, background, and academics.

✅ A high school transcript for 9th, 10th and 11th grade, including final junior year grades (You may submit an unofficial copy. Screenshots and pictures are accepted!).

✅ Make sure you can attend one of our two programs: Saturday, September 28 to Monday, September 30; or Saturday, November 2 to Monday, November 4.*

Program space is limited, please apply as soon as possible. Applications are considered as they are submitted before the following deadlines.
‎

‎Program Date	Application Deadline
Mosaic I: September 28 to September 30 (FULL)	September 13
Mosaic II: November 2 to November 4	October 11

*If admitted to the program, the Mosaic Team will assign you a program date based on the dates you indicate that you are available on the application.

Student Information

First Name (As shown on Government-issued identification)*

Last Name (As shown on Government-issued identification)*

Preferred Name

Pronouns (optional)

I consent to Mount Holyoke College to address me by my preferred name and use my pronouns in all communications to me and my parent/guardian.*

Yes, I consent

No, I do not consent

Date of Birth*

Sex*

Female

Male

If you would like the opportunity, we invite you to share more about your gender identity below.

How did you hear about Mosaic? Select all that apply.

Counselor/CBO

Email campaign

Word of mouth

Other (please specify)

Contact Information

Email Address*

Confirm Email Address*

Mobile Phone*

Text message opt-in*

Yes, I would like to receive text messages from Mount Holyoke College

No, I would not like to receive text messages from Mount Holyoke College

Address*

Country

Street

City

Region

Postal Code

Demographic and Family Background

Race and Ethnicity

Are you of Hispanic or Latine/o/a/x descent?

Yes

No

Regardless of how you answered the previous question, please select one or more of the following ethnicities that best describe you (use the CTRL key to select more than one):

Please further specify your racial or ethnic identity:

Family Information

Have any of your parents or legal guardians earned a Bachelor's Degree or higher? (either in the United States or internationally)*

Yes

No

Are you going to be the first person in your family to attend college in the United States?*

Yes

No

Do you receive free or reduced lunch?*

Yes

No

Not sure

Legacy Affiliation

Has a member of your family attended Mount Holyoke College?*

Yes

No

I prefer not to answer

Please fill out the following information: Name/Class Year (if known) and relationship

Parent/Guardian Information

Parent/Guardian 1

First Name*

Last Name*

Email*

Relationship*

Does this parent/guardian share your mailing address?*

Yes, this parent/guardian shares my mailing address

No, this parent/guardian has a different mailing address

Parent/Guardian 1 Address

Country

Street

City

Region

Postal Code

Do you wish to submit information for an additional parent/guardian?*

Yes

No

Parent/Guardian 2

First Name*

Last Name*

Email*

Relationship*

Does this parent/guardian share your mailing address?*

Yes, this parent/guardian shares my mailing address

No, this parent/guardian has a different mailing address

Parent/Guardian 2 Address

Country

Street

City

Region

Postal Code

Academic Information

High School Information

Name of High School*

# of Years Attended*

Add another High School?

Yes

No

Name of High School*

# of Years Attended*

High School Graduation Year*

Anticipated Entry Term*

I affirm that I am a high school senior who will be entering college in Fall 2025*

Yes

No

Community-Based Organization Affiliation (i.e. A Better Chance, Posse, QuestBridge, Minds Matter, Chicago Scholars, Prep for Prep, etc.)

School/Community Based Organization Counselor Information

Counselor's First Name*

Counselor's Last Name*

Counselor Email*

Counselor Phone

Academic Information

Cumulative Grade Point Average*

GPA Scale (4.0, 5.0, 100, etc.)*

Is your GPA on a Weighted or Unweighted Scale?*

Weighted

Unweighted

Class Rank*

Graduating Class Size*

Please enter the rigor of your school*

School Rigor

Please list all of the classes you plan to take senior year.*

Upload your high school transcript for 9th, 10th, and 11th grade, including final junior year grades (You may submit an unofficial copy. Screenshots and pictures are accepted!).*

Academic Interests

Please select up to three academic interests:

1st Academic Interest*

2nd Academic Interest

3rd Academic Interest

Academic Short Answers

In 1-3 sentences, tell the reader about your favorite subject and why.*

Please share any additional information about your academics. You can use this space to provide context/an explanation about lower grades, changes in schools, etc. (optional)

Co-Curricular Information

Please list the co-curricular activities that you are involved in using the following format:*
Name of co-curricular activity (years participated): 1-2 sentences describing your involvement or leadership.

In 1-3 sentences tell the reader about the co-curricular activity or involvement that is the most meaningful to you and why.

List any significant family responsibilities or work experiences.

Writing Samples

Short Answer Questions

Please answer the following prompts in 1-3 sentences
Hint: the why is VERY important to us.

How would your friends describe you to a complete stranger and why?*

If you could meet any fictional character who would it be and why?*

Who is the person that you admire the most and why?*

Can you discuss a topic or issue that you’re passionate about and explain why it’s important to you?*

Paragraph Answer Question

Please answer the following question in 1-3 thoughtful paragraphs

Every day, our students cultivate the competence, confidence, and courage to make an impact -- whether on a personal, community, or global level. Tell us your story. What forms your aspirations? How has your community shaped your way of thinking or perspective?*

Program Specific Information

If admitted, which program would you like to attend?* (our September Program is now full)

Saturday, September 28 to Monday, September 30

Saturday, November 2 to Monday, November 4

Either program is fine!

If selected for the program we will need some information from you in order to book your travel.✈️🚆🚗

Personal Car: If you are traveling 150 miles or less to Mount Holyoke College one way, you qualify for reimbursement of mileage for using a personal car.

Using the calculated distance from your departing address to campus, we will determine the reimbursement amount and mail you a check.
Toll fees will be reimbursed in addition to mileage.
Follow these instructions to calculate the distance from your departing address to campus. Submit the required Google Maps attachment of your trip.

Train: You may choose to travel to campus by train from any Amtrak station in the following states: CT, MA, NH, NJ, NY, PA, RI or VT.

Our office travel coordinator, Jennifer Dobson, will purchase your train ticket for you in advance of your trip. Jennifer will confirm your ticket purchase via email where you will also receive a QR code that serves as your boarding ticket for Amtrak.
You are responsible for your transportation to and from your nearest Amtrak station.
The Office of Admission will provide shuttle transportation between Springfield’s Union Station (your campus arrival terminal) and Mount Holyoke College.

Plane: If you are traveling 300 miles or more to campus, you must choose air travel as your mode of transportation.

Air travel will be arranged for you by our travel agent at the Travel Collaborative, Barbara Zudeck.
You are responsible for transportation to and from your departing airport.
The Office of Admission will provide shuttle transportation between Bradley International Airport (your campus arrival airport) and Mount Holyoke College.

Mosaic is for prospective students only. If a parent/guardian/family member wants to travel with the Mosaic attendee, they must make their own arrangements for travel and lodging. Mount Holyoke College will not fund travel or lodging for guests.

How would you like to travel to campus?*

Personal Car Travel Details

Submit a Google Maps document of the departing location to Newhall Admission Center, Mount Holyoke College. Use 33 College St, South Hadley, MA 01075 as the GPS address for directions. If the documents are not submitted properly, you may not be reimbursed for the mileage.
Mount Holyoke College will reimburse you 65.5 cents per mile. Costs for repairs or damages to a traveler's automobile while traveling to the College are considered the personal expense of the owner.
All travel accommodations are for students only. Family members and other guests will have to make their own arrangements if they would like to accompany the student.

Do you have access to a vehicle to attend the program?*

Yes

No

Please select train as how you would like to travel to campus.

Please upload a PDF of a Google Maps from the address you are traveling to Newhall Admission Center, Mount Holyoke College. Use 33 College St, South Hadley, MA 01075 as the GPS address for directions. *

Is the address listed above where we should mail your reimbursement check for mileage and applicable tolls?*

Yes

No

Address to Mail Reimbursement*

Country

Street

City

Region

Postal Code

Train Travel Details

Your ticket will be booked by our on-campus travel coordinator, Jennifer Dobson.
The College will provide shuttle transportation for you between Springfield Union Station and Mount Holyoke College. You are responsible for securing a ride to and from the Amtrak station in your area.
Your train ticket is non-refundable/transferable. Please check your schedule to ensure you do not have scheduling conflicts before registering for the program.
It is the responsibility of the student to keep the ticket in a safe place and not lose it.
All travel accommodations are for students only. Family members and other guests will have to make their own arrangements if they would like to accompany the student.

If you are from the following states: CT, MA, NH, NJ, NY, PA, RI or VT, what is the name of the nearest Amtrak Station?*

Air Travel Details

Air travel will be arranged for you by our travel agent, Barbara Zudeck from the Travel Collaborative.
The College will provide shuttle transportation for you between Bradley International Airport (BDL) and Mount Holyoke College. You are responsible for securing a ride to and from the airport in your area.
Your airline ticket is non-refundable/transferable. Please check your schedule to be sure you do not have scheduling conflicts before registering for the program.
All travel accommodations are for students only. Family members and other guests will have to make their own arrangements if they would like to accompany the student.

If you are more than 300 miles from Mount Holyoke College, what is the name of the nearest International Airport to you? Keep in mind that you will need to provide your own transportation from your home to the airport. *

Certifications

I understand that IF ADMITTED, in order to confirm your travel arrangements to the program I need to register for the event and submit the Waiver of Liability. I understand that failure to do so will result in forfeiture of my participation in Mosaic.*

I understand

My signature below confirms that all the information contained in this application is factually correct and honestly presented. I understand that I will only be awarded travel to the college if I am admitted to Mosaic.

I also acknowledge that if admitted to Mosaic I will be committed to meeting new people, open to building connections and bring my true authentic self to the program! 🙂

In place of your signature, please type your full name.*

Mosaic 2024 Student Application

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