Regents Bachelor of Arts Degree Application

Regents Bachelor of Arts Degree
Program Application
 

STUDENT ID NUMBER   

HOME PHONE    WORK PHONE

FULL NAME

CURRENT ADDRESS

EMAIL ADDRESS

DATE

PERSONAL DATA (This information is not required-used only for reporting)

DATE OF BIRTH

MARITAL STATUS
Single Married

GENDER
Male Female

PRIOR EDUCATION

H.S. DIPLOMA  VOCATIONAL/TRADE SCH.  1-2 YRS. COLLEGE (31-60 HRS) 
2-3 YRS. COLLEGE (61-90 HRS.)  MORE THAN 3 YRS. COLLEGE (91 HRS.) 

OTHER EDUCATION

Please provide all previous Colleges attended and dates of attendance:

(1) College/location/date

(2) College/location/date

(3) College/location/date

(4) College/location/date

PRESENT EMPLOYMENT
FULL-TIME
PART-TIME
NEITHER

EMPLOYER

EMPLOYER'S ADDRESS

JOB DESCRIPTION OR TITLE

GOALS STATEMENT

Area of specialization, general area of study, or career for which you wish to prepare:

Have you ever been admitted to any other RBA Degree program in West Virginia?
Yes
No
If yes, where?