Rutgers University - Summer Advanced Placement Institute

Visiting Student Registration Form

Fields marked with * are required.

* First Name:
Middle Initial:
* Last Name:
* Social Security #:	- -
* Gender:	Male Female Please select your gender
* Date of Birth:	MM/DD/YYYY
* Place of Birth:
* Permanent Home Address:
* City:
* State:
* Zip Code:
If New Jersey, provide County:
* Email:
* Phone:	xxx-xxx-xxxx

* I have been a legal resident of New Jersey for one year: Yes No This is required If No, what State?

If yes, select begin date:

*Do you have a NJ Driver's License? Yes No This is required

*Are you currently paying New Jersey income tax? Yes No This is required

*Are you a New Jersey high school graduate? Yes No This is required

*Please indicate Citizenship status: US Non-Citizenship Non-Immigrant This is required Visa Type:

* Country of Residence:

*Have you previously attended Rutgers University? Yes No This is required

*Have you been previously assigned a RUID? Yes No This is required

*Are you a Rutgers Alumnus/Alumnae? Yes No This is required

*Present Affiliation:

I am a student from another University/College
I have no present academic affiliation
I am a High School Sophomore or Junior applying for a summer course(s)
This is required

Course Information:


	*Course Title	*School #	*Subject #	*Course #	*Section #	*Reg Index #	Special Permission #
1.
2.
3.
4.

* Special Permission # is only needed if the course(s) you are registering for is by special permission only. Otherwise, please leave blank.