Online Application for Admission

Name *

First

Middle

Last

Date of Birth *

Phone Number *

Email Address *

Country of Birth *

Country of Citizenship *

Overseas Address *

Local U.S. Address

Emergency Contact Name *

First

Last

Relationship To You *

Emergency Contact Phone Number *

Emergency Contact Email *

Status You Will Be Attending As *

If Other Please Specify

Program *

Number of Weeks *

Select Year *

Select Month *

Courses *

Please check all that apply

Airport Pickup

Flight Information

If yes, please provide your flight details

Housing Placement

Duration of stay

Housing Checklist

I would like meals
I do not require meals
I am ok with pets
I am ok with children

Please check all that apply if you require housing placement

Credit Card Number

In order to process your Application for Admission you will need to pay your $150 non-refundable application fee.

Name On Card

Expiration Date

Security Code

Card Type

Authorization

Yes I understand

By clicking the box you understand and authorize that Rosemead College will charge you a $150 application fee with the credit card information you've provided.