Rupanuga Vedic College
5201 The Paseo
Kansas City, MO, 64110
Phone: (816) 924-5619 or (800) 340-5286
Fax: (816) 924-5640

Registration Form
Instructions:
1. Select Print (or Print Preview to see the layout) from your browser menu.....
2. Fill in all information and mail to address above


 

1. Name: __________________________________________________

Last, First, Middle, Other

2. Mailing Address: ____________________________________________________________________________________

_____________________________________________________________________________________

City, State, Zip Code

3. Home phone: (___) ____________Business phone: (___)_____________

4. Date of birth: mo/dy/yr ____________________ Social Security#:______________________________

 

5. Schools attended: (year: from-to/grade)___________________________________________________ _____________________________________________________________________________________

_____________________________________________________________________________________

6. Special Interests: ___________________________________________________________________

7. ISKCON Experience (if any) __________________________________________________________

8. Copies of certificates enclosed (for credit evaluation and transfer):

1.________________________________________________________________

2..________________________________________________________________

3._______________________________________________________________

9. References: (please attach)

I have read the entire Rupanuga Vedic College Prospectus; I understand the rules, terms and conditions and shall abide by them.

Signature ______________________________

Date: (mo/dy/yr)_________________

1. PERSONAL

A. Birth place:(city/state/country)______________________________

B. Marital Status: single____ married____ engaged____ divorced____

C. If married or divorced please give dates:______________________

D. Social security number:____________________________

Nationality:___________________Passport number: _____________

2. FAMILY

A. Names and ages of children:

Name:_______________age:____ Name:_______________age:_____

Name:_______________age:____ Name:_______________age:_____

Name:_______________age:____ Name:_______________age:_____

B. Father (name):______________(age):____(Occupation):________

Address: (street) _______________________ (city)_______________

(state)___________(zip)________(country)_____________________

C. Mother (name):______________(age):____(Occupation):________

Address (if different from father): (street)____________________(city) ____________ (state)________(zip)_______ (country)_____

D. Brothers: (name)_____________ (age)____(occupation)_________ (name)______________ (age)____ (occupation)________________

E. Sisters: (name)_____________ (age)____(occupation)_________ (name)______________ (age)____ (occupation)________________
F. Others to contact in emergency:

(name)_________________(phone)____________(relation)__________

(name)_________________(phone)____________(relation)__________

3. HEALTH

A. Height:_____ Weight:_____ Color of Hair:_____ Color of eyes:_____

B. Allergies:________Physical handicaps or limitations:_________

C. Please list medical treatments you have had: type:date:places:______________________________________________

type:date:places:______________________________________________

D. Problems now? Please explain: __________________________

E. Are you currently taking any medications? Yes___No___

F. What kind?___________________________________

G. Do you have any history of mental or emotional illness? __

H. Give details_________________________________________

I. Have you ever been admitted to a mental institution?_______

J. If so, give dates admitted and released:_____________________

K. Do you receive social security? Yes ___ No ___ If yes, what type: Since when and from where________________________

L. Further explanation:_____________________________________

4. MILITARY SERVICE

A. Did you serve in the military? Yes ___ No __

B.If yes, give branch___________Date entered ____________

C.Date discharged_________Type of discharge ____________

D.Highest rank held ______________________

E. Valuable experience or training____________________________

5. EDUCATION

A. Circle highest grade completed: Elem. 6 7 8 H.S. 1 2 3 4

1. College 1 2 3 4 5 6 7 8 _______________________________

B. High school diploma or GED? Yes ___ No ___ Date received:

C. School/college Name Location Dates Class Rank

1. _________________________________________________

2. _________________________________________________

3. _________________________________________________

4. _________________________________________________

D.College or university major field of study:_________________

E. Degree(s) achieved:__________________________________

F. Academic honors or other special recognition: ___________________________________________________________________________________

G. Extracurricular activities and offices held:_____________

_______________________________________________________

H. Foreign languages. Read / Write / Spoken:_____________

I. Travel experience (countries and dates): ______________

_______________________________________________________

6. EMPLOYMENT HISTORY

A. Employer Location Position Held Date: (From —To)

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

7. LEGAL HISTORY

A.Have you ever been convicted of a misdemeanor (minor crime)? Yes __ No__

B.If yes, please explain, giving dates and places._________________________________________________

_____________________________________________________________________________________

C.Have you ever been convicted of a felony? Yes ____ No ____

D.If yes, please explain, giving dates and places. ______________________________________________________________________________________

______________________________________________________________________________________

E.Have you ever been in prison? Yes ____ No ____

F.If yes, please explain, giving dates and places.______________

______________________________________________________________________________________

8. Driving experience

A.Do you have a driving license? Yes ___ No ___ If yes, please give date first received: ______________________________

B. License number: ___________________ Country _____________

State: __________________Date of expiry: ____________
C. Type of license: ____________ Ever revoked? Yes ____ No____

D. Describe your driving experience:__________________________________________________________

E. Car accidents: Yes ___ No ___ If yes, please list dates and explain:_______________________________________________________________________________


9. Miscellaneous

A. Do you have any financial debts or obligations? Yes ___ No __ If yes, please give amounts and details:_________________________________________________________________________________

______________________________________________________________________________________

B. Do you own any possessions (houses, cars, or other things)? Please list:____________________________________________________________________________________

C. Did you ever receive any awards? Please give dates and explanation:_____________________________________________________________________________

D. Please give a brief explanation of your previous religious faith, training and understanding:___________________________________________________________________________

______________________________________________________________________________________

E. Have you practiced yoga or meditation? Please explain.__________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

F. Significant books read:________________________________________________________________

______________________________________________________________________________________

G. What are your interests?_____________________________________________________________

_____________________________________________________________________________________

H. What was your first contact with ISKCON?_________________________________________________

I. What further contact have you had with ISKCON?__________________________________________

_____________________________________________________________________________________

J. Comments:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

____________________________________________________________

***Please copy these forms, fill out and send to RVC.***