Name *

First Name

Last Name

Local Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Local Phone Number *

(###)

###

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What type of student?

High School

Professional School or Trade School

College (undergraduate)

Graduate Student

Post-Doc or Scholar

Other

How did you hear about us? *

Website

Facebook

Google (or internet) search

Newsletter

College/University

Friend

Other

How long do you plan on being in Rhode Island? *

What best describes your residency in the Rhode Island area?

Permenant Resident

Long-term Visitor (more than 3 years)

Medium-term Visitor (1-3 years)

Short Term or Temporary Visitor; (Less than 1 year)

None of the Above (live outside the RI Area)