Transient Reactivation Form


Complete and submit this form if you wish to take classes as a Transient (Guest) student at Rhodes State College. This form should only be completed by individuals who have received grades from Rhodes State College and/or Lima Technical College in the past.

Planned Term to Enroll 
Student ID (begins with an "R" followed by a series of numbers) If you do not know this number...leave this blank.
Date of Birth - mm/dd/yy 
Gender
First Name 
Last Name 
Middle Initial 
Maiden/Previous Name If Applicable
Street Address 
City 
State 
Zip Code 
Phone Number 
Email Address 
Will you be using Military Educational Benefits 
Are you currently serving in the U.S. Armed Forces or are you a veteran? 
Are you a U.S. Citizen? 
If no, please select one of the following?
Have you resided in Ohio for the immediate past 12 months? 
If no, in which state are you a legal resident?
Rhodes State has permission to release my name, address, telephone number, college major, participation in officially recognized activities and sports, dates of attendance, degrees and awards received (including Dean's list) and most recent previous educational agency or institution attended to news media, car pool lists, or other appropriate agencies. 
Last term you received grades from Rhodes or LTC (If you can recall)
If male, aged 18-26, have you registered for the Selective Service? 
If yes, enter your selective service number.
What is the name of your home College/University
Full Name of Emergency Contact 
Emergency Contact's relationship to you 
Emergency Contact's Phone Number 
By typing my full name in this box, I confirm that I am the student named above and that information is correct on this form