GR RFI Internal Form

*All items with an asterisk must be completed. If data turns red then check format.

*First Name

Preferred First Name

*Last Name

Birthdate

Phone Number

May we text you?

Yes

No

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

You are going to be a(n)...

Graduate

International Graduate

Visiting Student

How would you like to take classes?

On Campus

Online

Please select a Program/Major

Concentrations

When are you planning to start?

Are you or were you associated with the military, if so please choose from the list below.

Will you be using military benefits, choose from the list?

EAP

GI Bill

MFEP

TA

Source Partner Agency

Source Event Type

Source Event Detail

Source Event Detail 2

*Entered by (Full Name)