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To submit an application to our school, please complete the following form and select Submit Application.

Rend Lake College does not discriminate in any of its policies on the basis of race, color, national origin,
sex, disability, or any other status protected by law. Questions about Title IX or Disability Access may be
directed to titleix@rlc.edu or das@rlc.edu, respectively.
Title IX requires the college not to discriminate on the basis of sex in either admission or employment.
Inquiries about the application of Title IX to the college may be referred to the Tile IX Coordinator,
the Assistant Secretary for Civil Rights, or both.

Title IX Coordinator - Chad Copple, 618-437-5321, Ext. 1237 - copplec@rlc.edu
Title IX Deputy Coordinator - Angie Kistner, 618-437-5321, Ext. 1221 - kistner@rlc.edu
Title IX Deputy Coordinator - Henry Leeck, 618-437-5321, Ext. 1790 - leeckh@rlc.edu
Read our policy.

= Required

Personal Information

First Name
Middle Name
Last Name
Nickname
Date of Birth
Former Last Name
Social Security Number *While disclosure of his/her social security number may be voluntary, a student requesting financial aid/scholarships or expecting to receive tax information will be required to provide his/her social security number.

Address Information

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Address Line 2
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Postal Code
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Contact Information

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Phone Numbers (Exclude Country Code)

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Demographic Information

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Veteran Status
Retired?

Citizenship Information

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Secondary Citizenship
Visa
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Primary Language
Months in Country

Government Information

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Visa Country Issued
Visa Expiration Date
Passport Number
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Passport Expiration Date

Academic Information

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Interested in Extracurricular Activities?

Emergency Contacts

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2. Middle Name
3. Last Name
4. Relationship
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Education History

Degrees

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5. Institution Name
6. ETS Code Search
7. City
8. State
Institution Name

ETS Code

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School Policy

Select "I accept" to confirm that you have read and fully understand the terms and conditions set forth in our Application Policy

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