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Ripon College Self-Identification Form

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Thank you for taking a moment to complete the 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

Birthdate

Contact Information

Email Address

Home Phone

Mobile Phone

Mailing Address

Mailing Address

Country

Street

City

Region

Postal Code

Student identification information

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

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

Yes

No

Birth-given Sex

Gender identity

What are your preferred pronouns?

Ethnicity
(Select one or more)

Ethnicity
(Select one or more)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Please specify:

Hispanic/Latino

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?

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

First Year

Sophomore

Junior

Are you a transfer student?

Are you a transfer student?

Yes

No

Parent information

First Parent/Guardian

First parent/guardian relationship:

Did your first parent/guardian earn a bachelor's degree or graduate from a four year college or university?

Did your first parent/guardian earn a bachelor's degree or graduate from a four year college or university?

Yes

No

If yes, what is the name of the institution?

Please provide your parent/guardian email here:

Second Parent/Guardian

Second parent/guardian relationship:

Did your second parent/guardian earn a bachelor's degree or graduate from a four year college or university?

Did your second parent/guardian earn a bachelor's degree or graduate from a four year college or university?

Yes

No

If yes, what is the name of the institution?

Please provide your parent/guardian email here:

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?

Do you have a physical disability?

Yes

No

Please specify:

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

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.

Today's date

Today's date

^Portal Directory

Ripon College
Office of Admission
300 W. Seward St.
Ripon, WI 54971
Phone: 920-748-8709
Email: adminfo@ripon.edu

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