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CEL-Application-for-Admission - Application for Admission...

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Application for Admission $35 application fee required The Center for Extended Learning Rochester College-Est. 1959 800 W. Avon Rd Rochester Hills, MI 48307 www.rc.edu/cel Personal Data Last Name _________________________________________ First Name __________________________________ Middle Initial _____________ Maiden Name _________________________________________________ Preferred Name ________________________________________________ Address ________________________________________ City ______________________________ State __________ Zip Code __________________ Home Phone ___________________________ Cell Phone ______________________________ Work Phone _________________________________ E-Mail Address (if applicable) __________________________________________________________________________________________________ Social Security Number ______________________________________ Birth Date (Mo/Day/Yr) __________________________________________ Sex: Male Female What is your religious preference _________________________________________________________________ Please list any relatives who have previously attended Rochester College ____________________________________________________________ Have you previously attended Rochester College? Yes No If yes, please list year and former name __________________________________________________________________________________________ Have you been convicted of a criminal offense other than minor traffic violations? Yes (attach thorough explanation) No Have you, for any reason, been suspended or dismissed from an academic institution? Yes (attach
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  • Fall '08
  • Staff
  • ROCHESTER COLLEGE, Rochester College ____________________________________________________________, Rochester Hills

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CEL-Application-for-Admission - Application for Admission...

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