Rapid Maroons Interest Form

* denotes a required field

Demographic Information

First Name/Given Name *

Last Name/Surname *

Preferred Name (What would you like your professors to call you? - If different from your First Name (Given))

Birthdate *

Virginia Community College System (VCCS) Student ID Number

Contact Information

Student's Email Address *

Student Cell Phone*

Program Information

Permanent Address*

Country

Street

City

Region

Postal Code

The Rapid Maroons program is designed to prepare participants to meet Roanoke College's academic requirements all the while enabling them to be integrated into a community of student life at both Virginia Western Community College and Roanoke College. Participants in the program are encouraged to complete their associates degree from Virginia Western before transferring to Roanoke College.

What term do you anticipate entering Roanoke College?*

HIDDEN FIELD - Student Type

HIDDEN FIELD - FTPT Status

Which VCCS school are you currently attending?

HIDDEN FIELD - College CEEB

HIDDEN FIELD - School Type

What are your TOP THREE area of academic interests?*

Program participants will enjoy many privileges and opportunities available to Roanoke College students, such as clubs and organizations, and athletic, artistic, and community events. You should note that there will be a Rapid Maroons Program Participation fee of $98 annually charged.

Would you like to participate in activities during your time as a Rapid Maroon?

Yes

No

Academic History

How many semesters have you completed at your current VCCS school (EX: 3)?*

Please upload an unofficial copy of your most recent VCCS transcript.

Please list the VCCS classes you are currently enrolled in

Emergency Contact Information

Name of emergency contact*

Relationship of emergency contact*

Parent

Sibling

Relative

Other

If other, please explain

Emergency contact phone*

Emergency contact alternate phone

Emergency contact email

Family Educational Rights and Privacy Act (FERPA) Release Authorization

I acknowledge that Virginia Western Community College and/or New River Community College may release all requested records and recommendations to Roanoke College. I also understand that employees at these colleges may confidentially share information pertaining to my academic record and social conduct.*

Signature*

Date*