Adult & Continuing Education Part-time Study

Application for Undergraduate Part-time Degrees and Certificates at 24+ Credit Hours

* indicates a required field

* How do you plan to complete your college classes? Please check one:
Attend classes on RIT campus
Exclusively through online learning
A combination of on-campus and online classes

* Are you applying for Full-time or Part-time study? Please check one:
Full-time
Part-time

Personal Data

* Date of Birth (MM/DD/YYYY):
Gender:	Male Female

Name

* Last Name:
* First Name:
Middle:
Other Surname used: (on school transcripts, etc)

Permanent Address

* Number and Street:
* City:
* State:
* Zip Code:
* Home Telephone:
Work Telephone:
E-mail Address:
Are you a U.S. citizen:	Yes No

Will you need a visa form (I-20 or IAP-66) issued by RIT? Yes No

If you are currently in the United States, please indicate any type of visa you have: Student (F) Exchange Visitor Other

Country of Citizenship:
City and Country of Birth:

Optional Information

To assist us in accurately reporting the racial/ethnic composition of our student body, please indicate how you would describe yourself. You may choose one or more of these groups or choose not to respond. Refusal to provide this information will not subject the applicant to any adverse treatment in the admissions process.

American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White

Applicant Status
Please indicate the calendar year and academic quarter you plan to enroll.
Calendar Year: Fall    Spring    Summer

Have you applied to RIT before? Yes   No  (If yes, when? )

Do you plan to apply for financial aid? Yes No

Will you be applying for Veterans Educational Benefits? Yes   No

Are you an RIT employee or dependent of an RIT employee? Yes   No

* Have you ever been subjected to disciplinary action by any school, college, university or branch of the military? Yes   No
(If yes, please explain: )

* Have you ever been convicted of a violation of any state or federal law, other than a minor traffic violation? Yes   No
(If yes, please explain: )

Are you receiving or seeking support services from RIT's National Technical Institute for the Deaf? Yes   No

Program Selection
Please indicate the name and corresponding code of your first-choice program of study.
* Program Name:

Education and Background
Please list below any school you have previously attended and any you are currently attending, indicating the most recent school first.
High School

CEEB Code (if known)	Name of High School and Location	Starting Month / Year	Ending Month / Year	Date of Graduation

College(s)

CEEB Code (if known)	Name of College, Location, and Major Field (Including RIT)	Starting Month / Year	Ending Month / Year	Degrees Received

Classes This Year Please list any college-level classes you are taking this year.

Fall Term	Winter Term	Spring Term

Work Experience

Employer	Position	Dates of Employment	Hours/Week

By submitting this application you agree that all information contained herein is complete, factually correct and honestly prepared. Any misrepresentation of facts in your application may result in refusal or cancellation of admission to RIT.