Pre-College Enrichment Program (RBS - PREP) 2016 Application

Pre-College Enrichment Program (RBS - PREP) 2016 Application Rutgers Business School: Undergraduate - New Brunswick Office of Diversity Programs 100 Rockafeller Rd., Room 4028 Piscataway, NJ 08854

If you have any questions about completing this form, please contact Courtney Clarke, [email protected].

PLEASE SCAN AND EMAIL ALL APPLICATION MATERIALS TO: Charles A. Brown; Assistant Dean EMAIL: [email protected] or FAX: 973-353-1345

GENERAL INFORMATION (Please Print) Gender □ MALE □ FEMALE

Last Name First Name

Date of Birth (MM/DD/YYYY) Social Security Number

Street Address

City State Zip

Home Phone Number Cell Number

Email Address

High School Grade

Parent/Guardian Name

Parent Work Number Cell Number

Race/Ethnicity

Are you a United States citizen?  Yes  No

If no, do you hold a permanent Alien Registration Receipt Card (green card)?  Yes  No

1 (What visa do you hold? ______)

Are you a New Jersey resident?  Yes  No

If you are a New Jersey resident, have you lived in NJ since birth?  Yes  No

If no, when did you move to NJ?

Guidance Counselor Section

Please sign the Endorsement Statement below, scan and email or fax this application with the student's transcript and national test scores (PSAT, SAT, ACT, and AP Exams), and other application materials.

I have reviewed this application for the Rutgers Business School Pre-College Enrichment Program (PREP) at Rutgers Business School: Undergraduate-New Brunswick and endorse this student's application to enroll in a course at Rutgers during the spring 2016 academic semester as a Pre-College Enrichment Program student. I also understand that if the above endorsed student is admitted into the program and decides to leave the program before its completion, the referring institution will be penalized by having its name removed from future consideration of Rutgers University and Rutgers Business School Programs.

Guidance Counselor Name (Please Print)

Guidance Counselor Signature Date

(Direct) Phone Number

E-mail address

Application Essay

Please submit a personal essay that answers both the following questions: “What are the top three reasons you are interested in studying business in college? How will earning a college degree in business benefit me, my family, and my community?” 500 word minimum

I verify that the information submitted is correct. If I am accepted into the Pre-College Enrichment Program, I agree to conform to the policies and regulations of Rutgers Business School: Undergraduate- New Brunswick. I understand that any deviation may result in immediate dismissal from the program.

Student Signature Date

Parent Signature Date