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Rupanuga Vedic College Registration
Form
1. Name: __________________________________________________
2. Mailing Address: ____________________________________________________________________________________ _____________________________________________________________________________________
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)________________
(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: ____________ 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.*** |