Roger on the Road in Bergen County

Please update/complete the information provided for the student interested in attending the event.

Fields marked * are required.

Student First Name*

Student Last Name*

Student Email Address*

Confirm Student Email Address*

Student Birthdate* (for identification purposes)

What pronouns do you use?

Students updating or adding pronouns understand that RWU makes their best faith effort to incorporate use of the chosen information in their interactions, as well as any portals and/or systems whenever possible. Students must keep in mind that their families may be able to login to these portals/systems and view the same information.

Mobile Phone Number

Can we text you at this number?

Sure!

No thank you.

Beyond email or texting, do you also want to receive print mail (postcards and brochures)?

Yes

No. I'll go greener.

Mailing Address

Country

Street

City

Region

Postal Code

ACADEMICS

Hidden: Academic Level*

When would you plan to enroll?*

Are you a first-year or transfer student?*

Your first-choice major at this time

A second-choice major (if you have one)

What high school do you currently attend?

High school graduation

What college have you most recently attended?

PARENT CONTACT INFORMATION

Parent contact information will be used for event/visit communications along with keeping parents up-to-date on timely admission and financial advice and support.

Would you like to share parent details?

Yes

No

Parent/Guardian 1 Name

Parent/Guardian 1 Email

Parent/Guardian 1 Mobile

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Mobile

Event Specifics
Please answer the following question in order for us to provide the best event possible for you.

Total guests coming with the student