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

Virginia Commonwealth University encourages a community of trust, honesty, and integrity. Our mission is to advance knowledge and student success. To view VCU’s general policy governing admissions and enrollment, please refer to the VCU Bulletin.

If admitted, I understand my offer of admission is contingent on (i) a post-admission/pre-enrollment criminal history inquiry that does not reveal criminal history information that is determined to pose a threat to the university community; and (ii) satisfactory completion of in-progress coursework and graduation from high school, if applicable.

If admitted, I understand that the university may rescind my offer of admission for failure to provide complete and accurate information in the application process or for behavior contrary to the university's mission and values or in violation of the university’s policies, including, but not limited to, the Student Code of Conduct, the policy on Preventing and Responding to Discrimination, the Title IX Sexual Harassment Policy, the Sex-Based Misconduct Policy, and the Honor System.

I acknowledge that I have read and understand this information.

Virginia Commonwealth University encourages a community of trust, honesty, and integrity. Our mission is to advance knowledge and student success. To view VCU’s general policy governing admissions and enrollment, please refer to the VCU Bulletin.

If admitted, I understand my offer of admission is contingent on (i) a post-admission/pre-enrollment criminal history inquiry that does not reveal criminal history information that is determined to pose a threat to the university community; and (ii) satisfactory completion of in-progress coursework and graduation from high school, if applicable.

If admitted, I understand that the university may rescind my offer of admission for failure to provide complete and accurate information in the application process or for behavior contrary to the university's mission and values or in violation of the university’s policies, including, but not limited to, the Student Code of Conduct, the policy on Preventing and Responding to Discrimination, the Title IX Sexual Harassment Policy, the Sex-Based Misconduct Policy, and the Honor System.

I acknowledge that I have read and understand this information.

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**