APPLY TO RANDOLPH


NOTE: You will need to complete this form within 30 minutes of starting it or the page will time out and the submit button at the bottom will not work. We recommend printing it out, and then typing up the answers that require text input. Then you can cut and paste the information into the form rather than trying to complete it in 30 minutes.



PERSONAL/ACADEMIC INFORMATION
Proposed Year of Enrollment:  
Proposed Term of Enrollment:
* First Name:  
Middle Name/Initial:
* Last Name:  
Nickname (Preferred Name):
* Birth Date (mm/dd/yyyy):    
Sex:
* Street Address or PO Box:  
Address Line 2:
* City:  
State/Province:
Zip/Postal Code:
Country:
Home Phone:
Cell Phone:
* Email:    
Your Graduating High School:

Select a high school using the tools to the right.
US Students - Search by your High School's ZIP code:  
Intl Students - Search by country:  
Homeschool Students -
Can't find your school? Enter the full name here:
Your Graduation Year:  
Your Guidance Counselor's Name:
Are you Transferring from another College/University:
If transferring, what is your current institution's name:

Select an institution using the tools to the right.
US Students - Search by your institution's ZIP code:  
Intl Students - Search by country:  
Can't find your institution? Enter the full name here:
At this time I am interested in studying:

Please select any Activities in which you are involved:




Please tell us about any awards you have received (academic, athletic, clubs, etc.):
SAT CR:  
SAT MATH:  
ACT:  
Class Rank (your rank/total classmates):
Grade Point Average:  
Have you ever been dismissed for academic reasons:
Have you ever been dismissed for disciplinary reasons:
Have you ever been found guilty or convicted of a misdemeanor or felony:
RESIDENCY INFORMATION
Are you a U.S. citizen or permanent resident:
If not, of what country are you a citizen:
Social Security Number (optional, numbers only):  
If you are a US permanent resident or green card holder, please give us your alien registration number:
WE ARE REQUIRED TO ASK THE FOLLOWING, BUT YOUR ANSWERS ARE ALL OPTIONAL:
Ethnicity:
Race (select one or more):



DEPENDENT STUDENTS MUST PROVIDE PARENT/GUARDIAN'S NAME AND ADDRESS BELOW:
With whom do you make your permanent home:
Guardian Type:
Guardian's First Name:
Guardian's Last Name:
Guardian's Address:
Guardian's City:
Guardian's State/Province:
Guardian's Country:
Guardian's Zip/Postal Code:
Guardian's Email:  
Guardian's Home Phone:
Guardian's Cell Phone:
YOU MAY ADD A SECOND GUARDIAN'S INFORMATION BELOW:
Second Guardian Type:
Second Guardian's First Name:
Second Guardian's Last Name:
Second Guardian's Address:
Second Guardian's City:
Second Guardian's State/Province:
Second Guardian's Country:
Second Guardian's Zip/Postal Code:
Second Guardian's Email: 
Second Guardian's Home Phone:
Second Guardian's Cell Phone:
* Verification: 

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.