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Ripon College Self-Identification Form
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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
Birthdate
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1902
1901
1900
Contact information
Home Phone
Mobile Phone
Email Address
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
Female
Male
Gender identity
Male
Female
Non-Binary
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:
Mom
Dad
Stepfather
Stepmother
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:
Mom
Dad
Stepfather
Stepmother
No second parent/guardian
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:
Married Filing Jointly
Married Filing Separately
Single/Head of Household
Widow/Widower
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
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
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5
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31
2020
2021
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2024
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