Student Life Support Group Registration
Register to join our student life support group and connect with peers for support, discussion, and activities.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student ID Number
*
Academic Year
*
Please Select
Freshman
Sophomore
Junior
Senior
Graduate
Other
Major/Field of Study
*
Preferred Contact Method
*
Email
Phone
Text Message
What are your reasons for joining the support group or topics you are interested in?
*
Which days/times are you generally available to attend meetings?
*
Monday morning
Monday afternoon
Tuesday morning
Tuesday afternoon
Wednesday morning
Wednesday afternoon
Thursday morning
Thursday afternoon
Friday morning
Friday afternoon
Evenings
Weekends
Other
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any accessibility or accommodation needs?
How did you hear about the support group?
Please Select
Friend or peer
School counselor
Flyer/poster
Social media
Website
Other
Register
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