Coffee Chats @ 1820 Coffee House, Friday, October 28

* Indicates a required field or an issue in the form.

Student: Contact Information

First Name *

Middle Name

Last Name *

Birthdate *

Can the Texas A&M University at Galveston send text messages to your cell phone number?*

Yes

No

Cell Phone Number*

Email Address *

Mailing Address *

Country

Street

City

Region

Postal Code

Student: Current School Attending & Academic Interest

I am a prospective... *

Freshman

Transfer

What high school do you attend?*
Choose from the drop down list of schools

What is your academic interest?*

What is your expected entry term to Texas A&M University - Galveston?*

Student: Permission to Record

I do hereby consent and agree that Texas A&M University at Galveston has the right to utilize photographs, video, or audio of me (and/or my property) and to use these for promotion materials. I do hereby release Texas A&M University at Galveston, Office of Student Enrollment Services staff all rights to exhibit this work publicly or privately. I waive my rights, claims, or interests I may have to control the use of my identity or likeness in the photographs, video, or audio and agree that any uses described herein may be made without compensations or additional consideration of me. *

I agree

I disagree