RCC
Application for Re-Entry
First Name
Last Name
Suffix
Gender
Date of Birth
(mm/dd/yyy)
Social Security #
(SSN)
Please select one or more of the following that best describes you:
Are you Hispanic or Latino?
Do you reside outside of the United States?
Address Line 1
Address Line 2
City
State
Zip Code
Country
Are you a US Citizen?
Primary Phone Number
Email Address
Confirm Email Address
Please provide parent/guardian information. This information is used for emergency contact purposes.
Contact 1 First Name
Contact 1 Last Name
(Optional) Contact 2 First Name
(Optional) Contact 2 Last Name
Phone Number:
Have you received a degree since the original time of enrollment at Roxbury Community College?
Please choose the degree(s) awarded:
What is your anticipated major?
What year do you plan to take courses at RCC?
What term do you plan to enroll?
(Fall, Winter, Spring, Summer)
I certify that this information is true and accurate.
Date:
If you have completed all required questions you can click submit. If there are any remaining questions to answer you can click previous.