Rutgers-Camden Dual Admissions Enrollment Form Name* First Last CCC ID*Student Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender Male Female Non-binary Pronouns Preferred She/Her/Hers He/Him/His They/Them/ Their Other Other pronoun preferred?Semester/Year you began at CCC*Current GPA*Expected graduation date at CCC*Intended Major/Program at Rutgers University – Camden*Have you previously attended Rutgers University- Camden*YesNoIf yes, what years?*As a participant in the Dual Admissions Program, I authorize Camden County College and Rutgers University- Camden to exchange necessary personal information, as needed and as identified by The Family Educational Rights and Privacy Act, as Amended [FERPA], in order to facilitate my transfer to Rutgers University- Camden. I have read and understand the conditions of this Dual Admissions Agreement. I also understand that this Dual Admissions/Intent to Enroll form can be voided by me, the student, at any time with written notification to Camden County College’s Transfer Office and Rutgers University- Camden Office of Admissions.*YesNoCAPTCHACommentsThis field is for validation purposes and should be left unchanged.