RIO HONDO COLLEGE
Admissions Application Semester Fall [  ] Spring [  ] Summer [  ] 20____
Check the box that applies Employed in Corrections [  ] Law enforcement  [  ] other student [  ] 

Please print clearly and answer all questions:
1. Legal Name:
Last Name:_______________________   First Name:_____________________Middle Initial____
2. Address:
Number________________________ Street_________________________________________
Apartment Number_______
City_______________________________ State__CA____ Zip Code___________ Country_U.S.A__
3. Telephone Number:
Area Code _______ Number ______________________
4. Social Security Number*: ____________/_________/_____________
*refusal to provide SSN will not be used to deny admission to the college or any of its programs.
5. Birthdate:
Month ____ Day ____ Year 19___  
6. Gender: Male __Female __
7. Enrollment Status:
_______ New (Never enrolled in any college)
_______ New transfer (Have enrolled previously in college, but first time at RHC)
_______ Returning transfer (Previously attended RHC, but have since attended another college.
_______ Returning (Previously attended RHC, but did not attend RHC last semester.)
_______ Continuing (Enrolled at RHC last semester)

8. Residency:
Have you lived in California for the past two consecutive years? Yes __No __
9. Citizenship: Are you a U.S. citizen? Yes ___ No ___
10. I declare under penalty of perjury that the statements submitted by me in connection with determination of residency and all other matters are true and correct to the best of my knowledge. All materials submitted by me for purposes of admission become the property of Rio Hondo College. I understand that falsification or withholding pertinent data may result in my dismissal from the college.

Student Signature_____________________________________ Date______________