Adult and Transfer Application for Admission

I have applied to or been enrolled at Roanoke College before
When was this?

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First Name:
Middle Name:
Last Name:
Nickname:

Birthdate:	[mm/dd/yy]
Birthplace:
Social Security Number:
Sex:
Ethnic Group:	American Indian or Alaska Native Asian Black or African American White Hispanic or Latino Native Hawaiian or Pacific Islander
Religious Preference:	Other:

Street Address:
City:
State:
Zip:
Daytime Phone: (include area code)
Email:

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Applying for Term:
Student Status:
Residency:
Full/Part Time:

I would like to be considered for college and/or federal financial assistance.

If you are a special student, what course(s) do you want to take at Roanoke College?
List in order of importance the influences that led you to apply to Roanoke College:

Attention:

If you are under 24 years old and not married, please complete the Parent/Guardian Information below:

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Your parents/guardians are:

Occupation of father/stepfather/guardian:
Employer Name:
City:	State:

Occupation of mother/stepmother/guardian:
Employer Name:
City:	State:

show/hide foreign student details

I am a U.S. Citizen:	yes no

Country/Countries of Citizenship:
I Am A:	» Resident Alien Green card Visa type » Non-resident Alien I-20 required I-20 not required

show/hide high school details

List high school attended, or attending, including date(s) attended and date of graduation. Please give the official College Entrance Examination Board Code (CEEB Code). If additional space is needed, please use the space provided at the bottom of this form for Additional Information.
High School
Name:
City:
State:
CEEB Code:	look up CEEB code »
Dates Attended
From:
To:
Graduated:
Earned GED:

show/hide college details

List all colleges attended, or attending, including date(s) or anticipated date(s) of graduation. Please give the official College Entrance Examination Board Code (CEEB Code). If additional space is needed, please use the space provided at the bottom of this form for Additional Information.

College 1

Name:
City:
State:
CEEB Code:	look up CEEB code »
Dates Attended
From:
To:
Graduated:

College 2

Name:
City:
State:
CEEB Code:	look up CEEB code »
Dates Attended
From:
To:
Graduated:

To which other colleges do you plan to apply for admission?

What is your intended major at Roanoke College?

show/hide extra information

Are you or any relative currently employed by Roanoke College?
Relationship:
Have you ever been suspended or dismissed by any institution of higher education?:
Type of suspension:
School:
Term eligible to reapply:

Use the space below for any additional information which
you feel would be helpful in reviewing your application.

I certify this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any schools/colleges I have previously attended to release personal and academic information to Roanoke College. I agree that my college grades may be used for statistical studies or sent to my high school or junior college for evaluation purposes.

* Signature: * Date: [mm/dd/yy]

Adult and Transfer Application for Admission

Attention:

High School

College 1

College 2