Are you employed as a law enforcement officer? 

This program is restricted to members of law enforcement. Please complete our traditional application.

Traditional Application

Name Information

Legal First Name

Legal Middle Name

Legal Last Name

Suffix

Personal Information

Birth Date (mm/dd/yyyy)

Legal Sex

Maiden Name

Citizen Of

SSN:

If you are applying for financial aid, foundation scholarships or intend to receive year-end tax reporting documents, your social security number is needed.

Are you Hispanic or Latino/Latina?

Race

Race (Choose one or more)

Are you a veteran?

Branch of Military Service

Contact Information

Zip Code

Address (Number/Street)

Address, continued (as needed)

City

State

County of residence

Country

Primary Phone Number

Email Address

Confirm Email Address

Secondary Education

As part of the ILEPP, you are required to send your transcripts to Richland Community College, One College Park, Decatur, IL, 62522 or to records@richland.edu.  Please provide your name, date of birth, and that you are part of the ILEPP if submitting unofficial transcripts.

Degree Earned

Graduation Year

GED Completion Year

High School State

Select Institution from List

School Not in List

Select GED Institution from List

Name of School (not available in dropdown list above)

High School State

High School City/Town

Non-Discrimination Statement

Richland Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs. The following person(s) has been designated to handle inquiries regarding the nondiscrimination policies:

Jody Burtnett, Title IX Coordinator at phone 217-875-7211 EX 6288
Leanne Brooks, 504 Coordinator, at phone 217-875-7211 EX 6362

For further information on notice of nondiscrimination, visit http://wdcrobcolp01.ed.gov/CFAPPS/OCR/contactus.cfm for the address and phone number of the office that serves your area, or call 1-800-421-3481.

Signature Verification

I certify that all of the information on my Registration Form is correct and complete.

Planned Starting Month

Planned year to start program