Ripon College Self-Identification Form

Thank you for taking a moment to complete our Self-Identification Form.

While we may have some of this information on record, please answer these questions in their entirety as we know personal and family circumstances may change over time.
If you have questions about this form or have personal information you'd like to discuss privately, please contact Lisa Zeman at zemanl@ripon.edu.

Student information

First Name

Middle Name

Last Name

Birthdate

Contact information

Home Phone

Mobile Phone

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Student identification information

Are you a citizen, national, or permanent resident of the United States?

Yes

No

Birth-given Sex

Gender identity

What are your preferred pronouns?

Please specify:

Hispanic/Latino

Yes

No

Are there languages in addition to English being spoken at home? If so, please list below:

Academic information

When you start your Ripon College experience, what student year will you be joining?

First Year

Sophomore

Junior

Are you a transfer student?

Yes

No

Parent information

First Parent/Guardian

First parent/guardian relationship:

Did your first parent/guardian graduate from a four year college or university?

Yes

No

Please share the name of the institution your first parent/guardian graduated from:

Can we contact this parent/guardian? If so, please provide an email:

Second Parent/Guardian

Second parent/guardian relationship:

Did your second parent/guardian graduate from a four year college or university?

Yes

No

Please share the name of the institution your second parent/guardian graduated from:

Can we contact this parent/guardian? If so, please provide an email:

Additional Family Information

Select the category in which your family filed their last federal tax form:

Disability information

Students who have a disability may be eligible for services to assist them with their educational needs. Please answer the following questions so we can best serve you during your college experience:

Do you have a physical disability?

Yes

No

Please specify:

Do you have a learning disability (and/or Attention Deficit Disorder?)

Yes

No

Please specify:

Signature

The undersigned verifies that the above information is accurate and true.

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