PERSONAL/ACADEMIC INFORMATION |
Proposed Year of Enrollment: |
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Proposed Term of Enrollment: |
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I am applying as: |
(Attending during school hours; high school transcript and letter from principal required)
(High school transcript required)
(Select an institution using the tools below.)
US Students - Search by your institution's ZIP code:
Intl Students - Search by country:
Can't find your institution? Enter the full name here:
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* Legal First Name: |
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Middle Name/Initial: |
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* Legal Last Name: |
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Nickname (Preferred Name): |
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* Birth Date (mm/dd/yyyy):
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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: |
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Address Line 2: |
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* City: |
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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: |
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* Your Graduating/Attending High School:
Select a high school using the tools to the right.
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Your Graduation Year: |
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Have you been enrolled at RC before? |
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If yes, please list date(s): |
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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
(Required or submit Substitute Form W-9S) |
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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 FOR US GOVERNMENT REPORTING PURPOSES: |
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: |
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Guardian's Home Phone: |
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Guardian's Cell Phone: |
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REQUIRED STATEMENT OF INTEREST |
Please indicate which course(s) you are interested in taking: |
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Please indicate why you are interested in enrolling in course work at Randolph College: |
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How will this opportunity help with your future goals: |
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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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