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Au Pair Program Application

Last Name

First Name

Middle Initial

Mailing Address

City

State

Zip

Telephone

E-mail Address

Date of Birth

(mm/dd/yy)

Gender

Male

Female

Country of Citizenship

Country of Birth

Au Pair Agency

Counselor's Name

Counselor's Telephone Number

Counselor's E-mail

Dates of au pair program as indicated on your IAP66 (MM/DD/YY):

From

(mm/dd/yy)

Racial/Ethnic Origin (optional)

Asian or Pacific Islander

Black, Non Hispanic

Hispanic

White, Non Hispanic

Have you previously attended Ramapo College?

Yes

Please list ALL School/Colleges/Universities attended:

College / University

Location

From

month/year

# of Credits or Degree

College / University

Location

From

month/year

# of Credits or Degree

Text

College / University

Location

From

month/year

# of Credits or Degree

Au Pair Program Agreement

By signing this document, you signify that you understand the following:

I can only take courses listed on the Classes Available list posted at the Ramapo au pair webpage.
Once registration closes on 1/27 (11pm), I can no longer make changes to my course selection.

If I go to my first class and realize that I’m not able to continue in the course, I will notify the Office of Admissions immediately. I will then be withdrawn from the class and will not be able to register in another that semester. Refunds are ONLY made during the first week of class.

Audit student responsibilities include regular attendance as per the course attendance policy, all in-class activities and homework. Testing is optional.

Applicant Text Signature *

My text signature acknowledges that I fully understand and agree with the terms and conditions stated above.

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