Summer Session Application

Note: Admission to the summer session does not constitute admission to the degree program at Randolph-Macon College. Students wishing to enter the degree program should contact the Admissions Office. If a student is admitted to the degree program, credits earned during a summer session may be applied to that program.

Last Name:
First Name:
Middle Name:
 (if applicable)
Email Address:
Street Address:
Zip Code:
Home Phone:
Format: (804)752-7200
Cell Phone:
Format: (804)752-7200
Social Security Number:
*Marital Status:
Date of Birth:
Place of Birth:
State of Birth:
Country of Birth:
*Race Ethnic Group:

Are you eligible for Veteran's Benefits?

If yes, which chapter?
Have you previously enrolled full-time at R-MC?

Are you enrolled at R-MC for Spring classes?

Other colleges attended:
Name: Dates Attended:
Location: Degree Earned:
Name: Dates Attended:
Location: Degree Earned:
Where you ever dismissed or suspended from a college?

High School Attended:
Date of Graduation or GED:
Please register me for the following courses:
Available Courses:   Selected Courses:

Please note that, once this registration is confirmed, you are enrolled in these courses. You must notify the Director of the Summer Session in writing or via e-mail to cancel this Enrollment after May 28.

Housing Requested:

Note: Roommate requests will be honored only if both students request each other. Students will be assigned a room and a roommate based on the information given on this form.

Use of Brock Center Requested:
(Additional fee applies)

CURRENT R-MC STUDENTS: If you have a credit balance on your account and wish to have it applied to your summer fees, initial and date the box below:

Please use my credit balance toward summer fees:

Electronic Signature:

Prospective Students
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