Request for Information

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Who are you? *

Personal Information

First Name *

Preferred

Last Name *

Birthdate *
Used for record matching purposes

Are you a United States Citizen or Permanent Resident? *

Email Address *

Mobile Phone Number

Can we text you?

I agree to receive text messages from the University at Buffalo (By selecting this, I agree the University at Buffalo may contact me via SMS and MMS messaging. To opt-out, reply STOP to any message. Message and data rates may apply.)

Mailing Address

Country

Street

City

Region

Postal Code

Are you a veteran or member of the United States military? *

Student & Parent Information

Parent Relationship Type *

Your first name *

Your last name *

Your email address *

Student's first name *

Student's preferred name

Student's last name *

Student's email address *

Student's birthdate *
Used for record matching purposes

Is your student a United States Citizen or Permanent Resident? *

Is your student a veteran or member of the United States military?

Students Mailing Address

Country

Street

City

Region

Postal Code

Academic Information

Projected Start Term *

Student type *

First Area of Academic Interest *

Second Area of Academic Interest

Current school (search by name)