Vanderbilt University
Tuesday, May 30, 2017 

You have requested to enroll in the following event:
Title Fairfield County Vanderbilt & You
Date/Time Saturday, April 05, 2014
3:15 PM - 4:45 PM
City/Metro Area Fairfield, CT
Location Fairfield Public Library | Rotary Room
1080 Old Post Road
Fairfield CT 06824
To enroll, please complete the form below. (*Required)
*Student's First Name
Student's Middle Name
*Student's Last Name
Student's Preferred Name
*Street 1
Street 2
Zip/Postal Code
*Student's Area Code
*Student's Phone Number
Country Code
(if non-U.S. phone number)
*Student's Email
Gender Female Male
Date of Birth
Total number of people in your party
*High School Name
High School ETS Code
High School City
High School State
*Term for which you will be applying
*First-Time Freshman or Transfer?

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