PERSONAL/ACADEMIC INFORMATION |
Proposed Year of Enrollment: |
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Proposed Term of Enrollment: |
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* First Name: (Required) |
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Middle Name/Initial: |
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* Last Name: (Required) |
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Nickname (Preferred Name): |
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* Birth Date (mm/dd/yyyy): Invalid date (Required)
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Legal Gender: |
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Gender Identity: |
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Pronoun: |
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* Street Address or PO Box: (Required) |
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Address Line 2: |
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* City: (Required) |
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State/Province: |
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Zip/Postal Code: |
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Country: |
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Home Phone: |
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Cell Phone: |
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* Email: Invalid email (Required) |
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Your Graduating High School:
Select a high school using the tools to the right.
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Your Graduation Year: Invalid year |
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Your Guidance Counselor's Name: |
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Are you Transferring from another College/University: |
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If transferring, what is your current institution's name:
Select an institution using the tools to the right.
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At this time I am interested in studying: |
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Please select any Activities in which you are involved: |
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Please tell us about any awards you have received (academic, athletic, clubs, etc.): |
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SAT CR: Invalid score |
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SAT MATH: Invalid score |
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ACT: Invalid score |
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Class Rank (your rank/total classmates): |
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Grade Point Average: Invalid GPA |
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Have you ever been dismissed for academic reasons: |
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Have you ever been dismissed for disciplinary reasons: |
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Have you ever been found guilty or convicted of a misdemeanor or felony: |
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RESIDENCY INFORMATION |
Are you a U.S. citizen or permanent resident: |
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If not, of what country are you a citizen: |
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Social Security Number (optional, numbers only): Invalid SSN |
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If you are a US permanent resident or green card holder, please give us your alien registration number: |
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WE ARE REQUIRED TO ASK THE FOLLOWING, BUT YOUR ANSWERS ARE ALL OPTIONAL: |
Ethnicity: |
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Race (select one or more): |
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DEPENDENT STUDENTS MUST PROVIDE PARENT/GUARDIAN'S NAME AND ADDRESS BELOW: |
With whom do you make your permanent home: |
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Guardian Type: |
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Guardian's First Name: |
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Guardian's Last Name: |
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Guardian's Address: |
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Guardian's City: |
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Guardian's State/Province: |
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Guardian's Country: |
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Guardian's Zip/Postal Code: |
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Guardian's Email: Invalid email |
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Guardian's Home Phone: |
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Guardian's Cell Phone: |
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YOU MAY ADD A SECOND GUARDIAN'S INFORMATION BELOW: |
Second Guardian Type: |
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Second Guardian's First Name: |
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Second Guardian's Last Name: |
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Second Guardian's Address: |
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Second Guardian's City: |
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Second Guardian's State/Province: |
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Second Guardian's Country: |
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Second Guardian's Zip/Postal Code: |
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Second Guardian's Email:Invalid email |
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Second Guardian's Home Phone: |
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Second Guardian's Cell Phone: |
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* Verification: |
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By submitting this form I am indicating that the above information is complete, factually correct and honestly represented. In addition, it indicates that if accepted to Randolph College I will uphold the standards of the following Honor Pledge:
I pledge absolute honesty in my academic work and in all personal relationships at Randolph College. I will maintain the integrity of my word and I will respect the rights of others. Realizing that these standards are an integral part of life at Randolph College, I assume my obligation to uphold this honor pledge. If at any time I fail to live up to my obligation of this pledge, I will report myself to the Chair of the Judiciary Committee. I will also ask others to report themselves for any infraction of this pledge.
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