Mosaic 2025 Student Application

We are so excited that you’re interested in applying to Mosaic 2025! Before you get started please review the items needed to complete the application:

✅ 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 photos are accepted!).

✅ Make sure you can attend one of our two programs: Saturday, September 27 to Monday, September 29; or Saturday, November 8 to Monday, November 10.

You will not be able to save and return to this form. We recommend drafting your responses on a separate document before entering them in this form.

Program space is limited, please apply as soon as possible. Applications are considered as they are submitted before the following deadlines.
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Program Dates:	Application Deadlines:
Mosaic 1: September 27 - September 29	September 5
Mosaic 2: November 8 - 10	October 4

Student Information

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

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

Preferred Name

Pronouns (optional)

Date of Birth*

Sex*

Female

Male

Not declared

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):

Would you like to 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

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 2026*

Yes

No

You must be entering college in 2026 in order to apply for our program.

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

Approximate Size of Graduating Class*

Does your school offer any of the following types of classes?

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 Short Answers

In 1-3 sentences, tell the reader about your favorite academic 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 important to us.

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

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

Please share 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 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?*

Saturday, September 27 to Monday, September 29

Saturday, November 8 to Monday, November 10

Either date is fine!

Certifications

I understand that IF ADMITTED, in order for you to confirm my 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 2025 Student Application

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