Event Information Thanks for signing up for the our Rose Bowl prospective student reception on: Monday, December 30 2:00–3:30 p.m. DoubleTree Suites Santa Monica, Carousel Ballroom 1707 Fourth Street Santa Monica, California Light refreshments will be served and dress is casual. We hope to meet you there! Student Information If you are a parent or guardian, please fill our your student's information here. You will have a chance to enter your contact information on the next page of this form. Student Information First Name * Last Name * Preferred First Name The name you usually go by that's not your legal name. Middle Name Student's Email Address * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Phone Number Text Message - None -YesNo Can we send you text messages to this phone number? Student plans to enroll * - Select -Fall 2024Fall 2025Fall 2026Fall 2029Summer 2024Fall 2024Winter 2025Spring 2025Summer 2025 Mailing Address Mailing Address Address * Address (Apartment) Mailing Address Region Fieldset City * State * AlaskaAlabamaArmed Forces AmericasArmed Forces EuropeArmed Forces PacificArkansasAmerican SamoaArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMaineMassachusettsMarylandMarshall IslandsMichiganMicronesiaMinnesotaMissouriMariana IslandsMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUS Virgin IslandsUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingXX ZIP Code * Other Information Additional guests in your party 012345 Special accommodations / Interpretation needed Leave this field blank
