Anticipated Enrollment Term
(the name you prefer to be called in conversation)
Date of Birth
Social Security Number (###-##-####)
(leave blank if you do not have a Social Security Number)
Country of Citizenship
Race (choose all that apply)
(for U.S. addresses only)
International Address Line 2
(if you do not have a U.S. address, please enter your city/town, state/province, and postal code here)
(for KY, TN, and VA addresses only)
Primary Phone (###-###-####)
(U.S. Numbers only)
Can we contact you via text message?
High School Attended
Do you have a GED?
GED Testing Center
GED Test Date
Please note that Union College requires transcripts from all other institutions where course work was attempted.
Previous College 2
Previous College 3
In what state are you currently licensed as an RN?
RN License Number
(enter "none" if not currently employed)
Spouse or Dependent of Active Duty/Veteran
How did you hear about Union College?
I understand that it is my sole responsibility to inform the Union College Dean of Student Development of any criminal charges for which I have been convicted or immediately if I incur any criminal charges during my enrollment.
Equal Opportunity StatementUnion College does not discriminate on the basis of race, religion, creed, national or ethnic origin, age, sex, marital status or disability in administration of it's educational policies, admissions policies, scholarship and loan programs, athletic and other school administered programs.
By submitting this form, I certify that the information contained herein is factually true and my own work.