Accepted Student Breakfast

Personal Information

Student First Name *

Student Last Name *

Suffix

Student Preferred First Name

Student Birthdate *

Gender *

Student Email Address *

Student Cell Phone Number *

Would you like to receive text messages? *

Mailing Address *

Country

Street

City

Region

Postal Code

How many guests will you be bringing with you? *

Please note that you can only bring up to two guests.

Do you have an accessibility need? *

Please provide a brief description

Enrollment Information

What kind of student are you? *

Freshman (currently in high school or recently graduated from high school and attending college for the first time or under 25 years old)
Transfer (attending another college and want to transfer over to La Roche or over 25 years old)

Expected Enrollment Term *

Intended Major *

High School Information

In the High School Name field below, please type in "969999" and select "Home School"

High School Name *

High School CEEB Code *

Parent/Guardian Information

Would you like to add parent information? *

Yes

Please choose type *

First Name *

Last Name *

Cell Phone Number

Would your parent/guardian like to receive text messages?

Email Address *

Would you like to add another parent/guardian?

Please choose type *

First Name *

Last Name *

Cell Phone Number

Would your parent/guardian like to receive text messages?

Email Address *

Previous College/University Information

College/University Name *

College/University CEEB Code *