Skip Navigation

Login

 
   
 

For technical support, visit the IT Support Page.

Geropsychology Certificate Application

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

= Required

By submitting this online application, I certify this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize admission and enrollment. I authorize any schools or colleges I have previously attended to release personal and academic information to Rockford University. Further, I agree that my college grades will be used for statistical studies.

Personal Information

Are you a US Citizen/Resident Alien? If no, please contact the Office of Admission at 001.815.226.4050 to request an international application.

Address Information

Enter your Permanent address. You must reside in the State of Illinois to participate in the certificate program.

    1.  
Contact Information

List your preferred phone number first.

  1. Phone Type Country Phone Number Primary
Demographic Information

The following information is being collected for statistical purposes only. This information will not be considered for Admission purposes.

Ethnicity and Race Information

The following information is being collected for statistical purposes only. This information will not be considered for Admission purposes.

  1. Are you of Hispanic/Latino ethnicity or descent? Yes No
    Select one or more races with which you identify yourself:
    American Indian or Alaska Native
    Asian
    Black or African American
    Native Hawaiian or Other Pacific Islander
    White
Anticipated Certificate

The certificate program is not currently being offered in full-time semesters. Please select less than half if you plan on taking one 3 credit course and part-time if you plan on taking two 3 credit courses.

  1. Program Full/Part-Time
Employment
  1. Employer Name Position Start Date End Date
Education History

Please use the 'Add Another Institution' link to list all high schools, colleges, and universities attended (most recent institution first).

Have you received a GED? If yes, include information below in regards to the institution issuing the GED certificate and note GED in the institution field. If you were homeschooled, note ‘homeschooled’ in the institution field.


  1. Degrees

     

Relatives

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

    I do not accept I accept