Medalist Profile Form

Congratulations on being selected as a Rensselaer Medalist! Please fill out the information below to ensure we have the correct and most up-to-date information for your record.

Academic Information

Entry Term*

Fall terms begin in August.

Spring terms begin in January.

Student Type*

Intended Major*

Biological Information

Prefix

First Name*

Middle Name

Last Name*

Suffix

Preferred Name

Date of Birth*

Sex Assigned at Birth

If you would like the opportunity, we invite you to share more about your gender identity.

Citizenship

Are you a United States Permanent Resident? (Green Card Holder)

Yes

No

Are you Hispanic or Latino?

Yes

No

Race (select all that apply)

Contact Information

Email Address*

Confirm Email*

Parent/Guardian Email Address

Permanent Address*

Country

Street

City

Region

Postal Code

High School Information

Please enter your High School Information below.
If you are Home Schooled, enter Home School Clearing House.

High School Name*

High School CEEB

High School Graduation Year

College/University Information

College/University Name*

College/University CEEB Code

Rensselaer Polytechnic Institute (RPI)

Medalist Profile Form