Policy Acknowledgement Form

The following resources are a compilation of campus policies, procedures and practices that have been created to foster an educational and social environment that is respectful, accountable and responsive to the College’s diverse community. They are some of the many good sources of information about the College. You may also want to consult the Bulletin and Course Catalog for the academic regulations.

We want to make sure you are aware of the policies and procedures so please take some time to go over these resources:

Student Handbook
Mount Holyoke College’s policy on plagiarism
Policies regarding tuition and billing

By completing this form and marking YES on each item, I confirm that I have read and understand these policies and procedures.

Should an issue arise, please contact us at graduateadmissions@mtholyoke.edu or 413-538-3478

First Name

Last Name

Birthdate

Mount Holyoke Email Address

I confirm the following:

I've read the Student Handbook.

Yes

I understand the Plagiarism Policy.

Yes

I understand that I cannot receive federal loans if I take less than four credits in a term. I will be responsible for the balance due for that term. I will contact Student Financial Services if I need to inquire about possible financing options.

Yes

I understand that the $150 Graduate Student fee is required of all incoming graduate students and is charged in my first semester. This fee supports special events like orientation and commencement, community building events, special guest speakers, and special co-curricular opportunities for learning.

Yes

I understand that no paper bills will be sent. I must check my bill online and I am responsible for paying any tuition not covered by scholarship or financial aid by the due date.

Yes

I understand that all graduate degree students have to take an online sexual assault prevention course.

Yes

MAT Initial Licensure Students: I understand there will be a field placement transfer fee of $350 each time I request, and am granted, a change to my practicum field placement.

Yes

MAT Initial Licensure Students: I understand that I must provide a copy of my Official Mount Holyoke College Graduate Transcript before I will be put forward to DESE for licensure. I also understand that students must be in good financial standing with the College in order to receive an Official Transcript.

Yes

Permission to photograph, videograph, or record

I hereby authorize the Trustees of Mount Holyoke College to record in any media (audio, video, or other media) my image, voice, speech or presentation and any interviews I may give to be used for educational, archival or other communications purposes. I understand that these images may be stored or distributed via disk or electronically via the internet. While it is the intent of the College to use the recordings for the purposes stipulated, I understand and agree that the recordings may be kept or used forever and may be used for the purpose the College deems fit including reproduction or distribution in any media as may now or hereafter exist.

I hereby release the Trustees of Mount Holyoke College, its trustees, officers, employees, volunteers, students, student associations and participating organizations, sponsors, vendors, program participants, agents and assigns (collectively, the Released Parties) from any and all liability related to dissemination or distribution of any recording of my participation in the program, presentations, or interview, or my image or voice, or the unauthorized reproduction, distribution, or display of the images or voice in print or any and all other media that may now or hereafter exist, and any alteration, distortion or illusionary effect, whether intentional or otherwise, in connection with said use, by any and all individuals or companies that are not Mount Holyoke College or the Released Parties.

I am at least 18 years of age and competent to sign this release. I have read this release before signing, I understand its contents, and I freely accept the terms.

Signature

I do NOT give Mount Holyoke College permission to use my image.

If you have any questions, please feel free to contact us at:
graduateadmissions@mtholyoke.edu
413-538-3478

Policy Acknowledgement Form

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