Graduate Admission Acknowledgement Form

This form is completed only after you have been formally accepted by the Office of Graduate and Undergraduate Admissions. In your admissions packet you should have received your formal offer of admission. If any conditions were placed on your admission, you must satisfy them prior to enrollment, unless otherwise noted. In order to register for your course/s you must submit this form. Please complete and return this form and submit either electronically, or mail it in the envelope provided in your admissions packet. It is important that we know your enrollment intentions.

*First Name:
*Last Name :
*RU ID Number (located on your admission letter):
Phone Number:
Date of Birth:	Month: Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: Select 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: Select 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
*E-mail Address:
Fields marked with an asterisk (*) are mandatory.
Please Provide Your Address Below:
*Street:
*City:
State:	Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
*Country:	United States ---------- Afghanistan ÅLand Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People'S Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People'S Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia And Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province Of China Tajikistan Tanzania, United Republic Of Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe
Fields marked with an asterisk (*) are mandatory.
Graduate Program of Admission:
You have been offered admission to program indicated above at Rutgers University-Camden for the Select Term Fall Spring * Select Year 2012 2011 2010 2009 2008 2007 *
*Please indicate your enrollment intentions:	I will attend Rutgers University-Camden.  I will not attend Rutgers University-Camden. Instead I will attend:
Fields marked with an asterisk (*) are mandatory.
Students with Disabilities
Designated "Coordinators for the Concerns of Students with Disabilities" serve the needs of students with disabilities at Rutgers University. In order to receive special accommodations or services, students with disabilities must first self-identify by presenting documentation of their disability to the appropriate Coordinator. Please indicate below whether you would like your name forwarded to the appropriate Coordinator(s) so that you can be provided with additional information concerning how to request accommodations.
Check One:                 YES    NO
Student Directory
Rutgers maintains a directory of current student names and other directory information such as campus P.O. Box, phone and email addresses, hometown address and phone, graduation year and major(s). The directory is made available through the Rutgers University web site (http://www.rutgers.edu). Students who do not want certain information to appear in their directory listing will be able to change their listing to hide that information. Instructions regarding how to change your listing can be found at the web site.
*  I confirm that the information I have given is correct.