Student Information

Student First Name

Student Preferred Name

Student Middle Name

Student Last Name

Home Phone Number

No Dashes

Cell Phone Number

No Dashes

I give permission to Rockford University to send me important updates via text messaging. (Standard message charges apply.)

Email Address

Birth Date

MM/DD/YYYY

Social Security Number

Your social security number is sensitive personal information which may be used to complete and process your application. We have established a secure Internet connection for your submission, and your social security number will be encrypted while in transit, but we cannot guarantee protection of your social security number from disclosure. By continuing with submission of your application and voluntarily disclosing your social security number, you assume the inherent risks of doing so and consent to transmission of your social security number over the Internet.

Address Information

Permanent Address

Permanent Address Type

Address

Apt. #

City

State/Province

Zip/Postal Code

Country

Foreign State/Province

Postal Code

Is your mailing address the same as above?

Mailing Address

Mailing Address Type

Address

Apt. #

City

State/Province

Zip/Postal Code

Country

Foreign State/Province

Postal Code

Personal Information

Citizenship Information

Citizenship Type

What is your country of citizenship?

Alien Registration Number

What is your visa type?

Demographic Information (Optional)

If you wish to be identified with a particular ethnic group, please select the choice that most accurately describes your heritage. No information you provide will be used in a discriminatory manner.

Are you Hispanic or Latino?

Gender

Religious Denomination

Family Information

What is the primary language spoken at home?

To whom should we send information?

Parent 1

Relationship

Title

First Name

Last Name

Email Address

Phone Number

No Dashes

Is the person's address the same as your permanent address?

Parent 1 Permanent Address

Permanent Address Type

Address

City

State/Province

Zip/Postal Code

Country

Foreign State/Province

Postal Code

Parent 2

Relationship

Title

First Name

Last Name

Email Address

Phone Number

No Dashes

Is the person's address the same as your permanent address?

Parent 2 Permanent Address

Permanent Address Type

Address

City

State/Province

Zip/Postal Code

Country

Foreign State/Province

Postal Code

Guardian

Title

First Name

Last Name

Email Address

Phone Number

No Dashes

Is the person's address the same as your permanent address?

Guardian Permanent Address

Permanent Address Type

Address

City

State/Province

Zip/Postal Code

Country

Foreign State/Province

Postal Code

Legacy Information

List the names of any family members who attended Rockford and their relationship to you.

Family Member 1

First Name

Last Name

Relationship

Add Another Family Member

Family Member 2

First Name

Last Name

Relationship

Add Another Family Member

Family Member 3

First Name

Last Name

Relationship

Add Another Family Member

Family Member 4

First Name

Last Name

Relationship

Referral

How did you find out about Rockford?

Your Enrollment Plans

When do you plan to enroll?

Student Type

Have you previously applied to Rockford University for enrollment?

For which term did you most recently apply?

Area of Academic Interest

(If you're not sure, that's OK; just select "Undecided.")

First Choice

Second Choice

Third Choice

Are you planning to enroll full-time or part-time?

Residency Preference

How many credits do you expect to transfer to Rockford University?

High School Information

Most Recent High School

High School

If Unknown School, please enter the full name of your current high school:

High School Graduation Date

Add Another High School

Previous High School 1

Previous High School Name

If Unknown School, please enter the full name of your current high school:

Add Another High School

Previous High School 2

Previous High School Name

If Unknown School, please enter the full name of your current high school:

What is your GPA?

Your cumulative GPA is the grade point average calculated based on all of your completed high school courses.

What GPA scale is used?

Please specify.

I do not know my GPA.

Academic Information

Have you taken or are you taking any courses for college credit?

College/University

College

If College is not listed above, please enter the full name of your College/University:

Add Another College

College/University 2

College

If College is not listed above, please enter the full name of your College/University:

Add Another College

College/University 3

College

If College is not listed above, please enter the full name of your College/University:

Add Another College

College/University 4

College

If College is not listed above, please enter the full name of your College/University:

Add Another College

College/University 5

College

If College is not listed above, please enter the full name of your College/University:

College/University Information

Please enter the country, state, city and name of all colleges and universities attended, starting with the most recent.

Search for Your School

If College is not listed above, please enter the full name of your College/University:

Attended From

Attended To:

What type of college/university in this?

Please Explain

Degree Earned

Please Explain

How many credits did you complete at this institution?

What was your GPA at this institution?

Add Another College

College/University 2 Information

Search for Your School

If College is not listed above, please enter the full name of your College/University:

Attended From

Attended To:

College/University Type

Please Explain

Degree Earned

Please Explain

How many credits did you complete at this institution?

What was your GPA at this institution?

Add Another College

College/University 3 Information

Search for Your School

If College is not listed above, please enter the full name of your College/University:

Attended From

Attended To:

College/University Type

Please Explain

Degree Earned

Please Explain

How many credits did you complete at this institution?

What was your GPA at this institution?

Add Another College

College/University 4 Information

Search for Your School

If College is not listed above, please enter the full name of your College/University:

Attended From

Attended To:

College/University Type

Please Explain

Degree Earned

Please Explain

How many credits did you complete at this institution?

What was your GPA at this institution?

Add Another College

College/University 5 Information

Search for Your School

If College is not listed above, please enter the full name of your College/University:

Attended From

Attended To:

College/University Type

Please Explain

Degree Earned

Please Explain

How many credits did you complete at this institution?

What was your GPA at this institution?

Additional Information

SAT and ACT Test Scores

Please provide information about your SAT or ACT scores (only one is required).

How many credit hours have you completed?

If you are transferring with fewer than 12 credit hours, please make sure we receive your official test scores.

Have you taken the ACT?

Have you taken the SAT?

ACT Test Details

ACT Composite Score

I do not know my ACT score.

SAT Test Details

SAT Composite Score

I do not know my SAT score.

Guidance Counselor Information

Please provide the following information about your high school guidance counselor. Once you submit your application, an email will be sent to your counselor alerting him or her to the steps required to help you complete your application

Counselor First Name

Counselor Last Name

Counselor Email Address

Submit

Have you ever been convicted of a felony?

Please Explain

Have you been suspended from any school?

Please Explain

I waive my right to review or access letters and statements of recommendation written on my behalf.

Certification

I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or any appropriate disciplinary action. I authorize the University to verify the information I have provided with all the schools I have attended. I agree to notify the proper officials of the institution of any changes in the information provided. I give my high school(s) and college(s) permission to send my official transcript(s) directly to Rockford University.

Please enter your full name in the signature box, verifying that you have completed the application.

Signature

Today's Date

Alpha Helix	American Chemical Society
Anime Club	Art Society
CAB	Chinese Club
Computer Science Club	Craft Club
eSports	Math Club
Movie Club	Multicultural Club
Nursing Student Organization	Other
Psych Society	Queer Transgender Identity Panel
Regents Against Modern Slavery	Rockford Education Club
Saudi Club	Spanish Club
Student Athletic Advisory Committee	Student Government
United Nations

Student Information

Address Information

Personal Information

Family Information

Legacy Information

Your Enrollment Plans

High School Information

Academic Information

Additional Information

Activities and Interests

Submit