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Richland College

Dallas County Community College District, Richardson, TX

Application

Personal Information Last Name:
First Name:
MI:
Student ID No. (if applicable):
DOB:
Age:
Gender: MaleFemale
Marital Status: SingleMarried
Street Address:
Apt.No.:
City:
State:
ZIP:
Home Phone:
Work Phone:
Cell Phone:
Email:
Are you a U.S. Citizen? YESNO(if "yes" please skip next question)
Do you have a permanent resident visa? YESNO
Alien Registration No:
Ethnic Background: Asian
Black or African American
Hawaiian/Pacific Islander
Hispanic or Latino
Native American/Alaskan Native
White
Do you get Financial Aid?YesNO
If Yes, what type? Grant Work Study Loan Scholarship
Scholarship(please specify):
Approximate annual family income:
Number of people in household:
How many hours do you work / week 0 1-19 20-35 36 or more
Do you have a HS diploma or GED? Yes No

Family Information Does either your mother or father have a four-year college degree? Yes No

Disabilities

This section is optional. You are not required to answer, but a response will help us to determine how we can best help you.

Physical Disability? Yes No
Learning Disability? Yes No
If Yes, please explain:

Needs Assessment College Grade Level Status: Freshman (0-29hrs)
Sophomore (30hrs+)
Other (explain):

What is your current GPA?
When did you first enroll at Richland
Number of hours transferred
List any other colleges attended:
How many hours are you enrolled in at Richland?
Current or planned enrollment at Richland? FT (12 hours or more) PT (12 hours or less)
Do you plan to graduate from Richland? Yes No
When do you expect to graduate?
Do you have a degree plan on file? Yes No
Services offered by S.O.A.R. Check all that apply to you. Career Counseling
TSI Assistance/Information
Study Skills
Academic Advising
Scholarship/Financial Aid information
Tutoring
Transfer Assistance
University Tours
Workshops
Knowledge of Richland's Campus Resources
Other (explain):

Confirmation

I certify that all of the above information is correct. I release the following information to Student Support Services: high school transcript, assessment scores, grade reports, financial aid records, and any other information from my records pertaining to my enrollment. I also authorize Student Support Services to release information from my records for the purpose of providing other services that I might need.

Yes No

Form will require a signature during your interview with staff.

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Richland College

Dallas County Community College District, Richardson, TX

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Application