Student Information Form | Rutgers Hillel

1Student Information

2Home Information

3Involvement & Interests

Name*
First Last
Nickname
Birthday
MM slash DD slash YYYY
Cell Phone*
Email*
Residence Hall
I am a(n)*
- Incoming Freshman
- Current Student
- Transfer Student
- Graduate Student
Proposed Graduation Year
School
Major

Parent/Guardian Name #1*
First Last
Home Address #1*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent Phone #1*
Phone #1 Type*
Parent Email #1*
Parent #1 is a Rutgers Alumni?
- Yes
- No
Parent/Guardian Name #2
First Last
Address same as above
- Yes
Home Address #2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent Phone #2
Phone #2 Type
Parent Email #2
Parent #2 is a Rutgers Alumni?
- Yes
- No