First Name Last Name
Unique Student School ID (RPCC Account)
SSN/Tax ID(Entire Number)
Date of Birth
Race/Ethnicity
Mailing Address Parish of Residence
Phone Email Address
Program Name Program CIP
Program/Class Start Date Program/Class End Date
Length of Progam (in weeks) Credential Name
REBOOT TUITION ASSISTANCE
APPLICATION
PROGRAM INFORMATION
(Complete All Required Information)
STUDENT INFORMATION
(ALL INFORMATION IS REQUIRED)
REBOOT ASSISTANCE AVAILABLE FOR ONE CERTIFICATION ONLY.
Return form to instructor or by email to Kathy Jones at kajones@rpcc.edu.
Please select your program from the drop-down list
Please select Gender
Select Employment Status
Employment Status (at time of enrollment)
Gender
Education Level
Select Education Level
Select Ethnicity
Select CIP Code