* indicates a required field
Student FIRST Name *
Student LAST Name *
Roosevelt ID *
Current Status *	Choose One First Year (Students with less than 15 credit hours) Transfer (Students with 15 credit hours or more)
Major *
E-Mail Address *
Address *
City, State ZIP *
Phone Number *	() -
Gender	Choose One Female Male
Special Needs	Please specify any special needs / disability / food allergies / vegetarian or vegan / other.
Emergency Contact Name *
Emergency Contact Phone *	() -
Session Preference *	Choose One Session I: Monday, January 11, 2010Session II: Tuesday, January 12, 2010Session III: Wednesday, January 13, 2010Session IV: Thursday, January 14, 2010 Please indicate which orientation program you would like to attend. Please note that there is a limited number of students who can attend each session. You will receive a confirmation email once your form has been processed.
Parent Orientation	If your parents will be attending, please indicate how many.
Parent Names	If your parents will be attending, please enter their names.
Total Participants *	Please remember to list all participants above.
Payment Information	All participants will be charged $25 each. Charges for all New Student Orientation participants will go directly onto your student account. Once you click "Submit", you are responsible for paying $25 per each participant listed above. Changes to your registration of requests for refunds will not be accepted within five (5) days of the orientation sessions.
IMPORTANT: Please only click SUBMIT once. Clicking more than once can create a double-registration which may result in being charged twice.