NEXT STEP Declaration Form

Personal Information

First Name *

Middle Name

Last Name *

Birthdate *

Social Security Number

Legal Sex*

Mailing address *

Country

Street

City

Region

Postal Code

Country of Citizenship*

Mobile phone with area code:

Would you like to receive text messages about important dates and events?

Yes

No

Email address *

Virginia Community College System (VCCS) Information

VCCS Email address *

Current institution in which I am enrolled *

VCCS ID Number *

VCCS Cumulative GPA

VCCS Earned Credits

VCCS Degree

If other, please type what degree:

If you are found eligible for the NEXT STEP VCU program, would you want a VCU ID card?

Yes

No

Other Institutions Attended

Have you attended any other colleges prior to enrolling at Reynolds Community College?

Yes

No

How many transferable credits have you completed at other colleges, excluding those earned at Reynolds Community College?

Virginia Commonwealth University (VCU) Information

Intended VCU major *

Semester I intend to enroll at VCU *

Have you previously attended VCU?

Yes

No

The Family Educational Rights and Privacy Act of 1974 (FERPA) permits disclosure of student records to officials of another school, school system, or institution of postsecondary education where the student seeks or intends to enroll, or where the student is already enrolled so long as the disclosure is for purposes related to the student's enrollment or transfer FERPA 34 CFR 99.31(a)(2).

By clicking the box, I acknowledge that, consistent with the federal Family Educational Rights and Privacy Act (FERPA), VCU and my community college will each share with the other institution my student information for purposes related to my enrollment at VCU.

Yes

**Hidden - CEEB code based on Selected School**

**Hidden - Student Type = Transfer **

**Hidden - Master Student Type = UG**

**Hidden - School Level of Study**

**Hidden - Static Device**

**Hidden - Next Step Catalog**