Please type or print CLEARLY.
I am applying for Fall 20 _______ Spring 20 _______ Summer 20 _______ (Ex. Fall 20 _____ )
Social Security # ________________ - __________ - ________________
(required for financial aid and tax credit verification)
Legal Last Name ______________________________________________________________________________________
Legal First Name ______________________________________________________ M.I. ___________________________
Preferred Name _______________________________________________________________________________________
Street Address ________________________________________________________________________________________
City _________________________________________ State _________________ ZIP Code _______________________
Gloucester County Resident?: Yes No If no, county of residence: _________________________________
Home Phone _________________________ Cell Phone ______________________________________________________
Email _____________________________________________ Date of Birth ____________ / ________ / _____________
month day year
Is your parent/guardian a full time employee of Rowan College of South Jersey
Name of High School City State Month/Year of Graduation
Last First ID #
Gloucester Campus
High School Option Participation Form
 Please provide
alien registration # ____________________
(A photocopy of Alien Registration Card or Visa must
accompany this application.)
 Please indicate
type of visa __________________________
(Non-resident aliens need to complete additional forms.
Please contact the Assistant Director, Admissions
at 856–681–6273.)
Are you a dependent of a Veteran?
Yes No
Both the State and Federal Governments periodically
require that we submit information on characteristics of
our students. Your response to this section is voluntary
but will help us in implementing our affirmative action
policy. RCSJ is an equal opportunity institution. This
information does not affect admission or placement.
Gender: Male Female
a. Do you consider yourself to be Hispanic/Latino?
Yes No
b. In addition, select one or more of the following
racial categories to describe yourself:
White Black or African American
Hispanic or Latino Two or more races
Asian American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
c. Is English your first language?
Yes No
The Board of Trustees is committed to providing a work and academic environment that maintains and promotes affirmative action and equal opportunity for all employees
and students without discrimination on the basis of certain enumerated and protected categories. These categories are race, creed (religion), color, national origin, nationality,
ancestry, age, sex (including pregnancy and sexual harassment), marital status, domestic partnership or civil union status, affectional or sexual orientation, gender identity
or expression, atypical hereditary cellular or blood trait, genetic information, liability for military service, or mental or physical disability, including AIDS and HIV-related illnesses.
For questions concerning discrimination, contact Almarie J. Jones, Special Assistant to the President, Diversity and Equity/Title IX/Compliance at 856-415-2154 or ajones@rcsj.edu.
For disability issues, contact Dennis M. Cook, Director, Department of Special Services, ADAAA/504 Officer at 856-415-2265 or dcook@rcsj.edu.
Application Revised 08/19
Student Signature ________________________________________________
(Please initial each line to confirm information has been read)
___ Students must be 15 years old or older and have completed freshman year of high school. Students may utilize HSOP
through the spring semester of their senior year. However, students age out after 18 years of age. Students must submit
an official high school transcript.
___ Students must satisfy the placement test requirements by taking the College’s placement exam, the Accuplacer or by submitting
qualifying SAT, PARCC and/or ACT scores. RCSJ Student IDs are issued upon submission of the HSOP Participation Form
and is required to schedule the Accuplacer. Please refer to RCSJ.edu/gc/Testing for more information.
___ HSOP courses are offered at a discounted rate on tuition and per-credit fees to unlimited number of courses.
Additional course required materials, textbooks and other fees are not included in the discounted rates.
This will affirm that permission is granted for _____________________________________________ to enroll in and attend courses
offered by Rowan College of South Jersey.
Student’s Name
It is understood that the student will be participating in an adult collegiate environment and may be asked to participate
in voluntary student opinion surveys as well as other college related events. As the parent/guardian, you have the option
to decline your child’s participation in any survey or collegiate event. To decline participation, please indicate this decision
in writing to the Office of Admissions. Additionally, your signature below acknowledges that upon registration for a college
course, the student’s records are protected by the Family Educational Rights and Privacy Act of 1974.
________________________________________________________________ _________________________________
Parent or Guardian’s Signature Date
________________________________________________________________ _________________________________
High School Guidance Counselor/Home School Official’s Signature Date
We want to keep in touch with you regarding upcoming recruitment and registration activities!
RCSJ may wish to contact you by phone, email and/or text message for outreach notifications which includes recruitment and
registration event reminders. While outreach notifications are highly recommended, they are optional. Therefore, please choose
your communication preferences below for outreach notifications.
I agree that RCSJ can contact me for outreach notifications using the following methods:
Personal Email
Text Message (SMS)
I certify that all the information on this participation form is true and complete. I understand that submitting this form
does not guarantee a seat in the program. I understand that if I plan to attend RCSJ after graduation, I must complete
the College application for admission during my senior year and provide my official high school transcript to complete
the admissions process.
___________________________________________________________ ______________________________
Applicant’s Signature Date
Please return this completed participation agreement to:
Rowan College of South Jersey—Gloucester Campus, Office of Admissions, 1400 Tanyard Road, Sewell, NJ 08080
The Security of all members of the campus community is of vital concern to Rowan College of South Jersey (RCSJ). In compliance with the Jeanne Clery Disclosure of Campus
Security Policy and Crime Statistics Act, an Annual Security Report (ASR) can be found online at RCSJ.edu/gc/Clery or a hard copy may be requested from the Office of Safety
and Security at 856-681-6287.
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