Student Referral Application

Please fill out the following form for each student you are referring to apply for acceptance into Redding College.

Use the Send button at the bottom of the page to send your referral to Redding College.

Referral From :

Student Name:

First

Middle

Last

Suffix
(ex: Jr., III)

E-Mail Address:

Phone Number:

Term Applying:

Social Security Number:

(ex: 000-00-0000) If none, check here:

Date of Birth:

Choose date

Gender:

Male Female

Address:

(Legal address, do NOT use P.O. Box or business address)

Street	Apt.
City	State or Province
ZIP or Postal Code	Country

Country of Citizenship:

Ethnic Identity:

(Optional)

High School Education:

(select one)
Not a high school graduate
Special admit student currently enrolled in K to 9
Special admit student currently enrolled in grade 10, 11, or 12
Currently enrolled in Adult GED program
Passed the GED or received high school certificate of equivalency/completion
Received non U.S. secondary school diploma/certificate of graduation
Received U.S. high school diploma

Year received high school diploma, GED, or certificate:

High School Attended (if applicable)

State or Province

Country

College Academic Level:

(select one)
This is my first time to attend a college or university
Attended college or university but did not complete requirements for Associate's Degree
I already have a college or university degree

If you attended college, from (year) to (year)

Number of credits seeking to transfer to Redding College, if any,
otherwise leave blank:

Have you ever been dismissed or disqualified from a college or university? Yes No

Language Capability (language you speak and write most frequently): English Other than English