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Rensselaer Admissions

 

Request for Materials

 

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Information Please enter the requested information. Please note that an asterisk denotes required information.

Required - indicates a required field.
Term of Entry:Required


Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Gender: Male Female Declined

What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

E-mail Address:
Verify E-mail Address:

Date of Birth: Month Day Year (YYYY)

U.S. Social Security Number: (999999999 or 999-99-9999)

Citizenship:

Student Type:Required

High School: Enter your High School Code (CEEB code) or use the look-up feature by clicking on the button. You may also enter the name and address of your school without a CEEB code.


Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Major:Required

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Release: 8.5.4