Rutgers University Senate

Committee Preference Form
Name*

First NameLast Name
Net ID*
Senator Type

FacultyPTL-FacultyStudentStaffAlumniAdministrator
Unit Representing
Email*
example@example.com
Campus Address

Campus Address

Room/Suite #

CampusState / Province

Postal / Zip Code
Campus Phone

Area CodePhone Number
Campus Fax

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number

Area CodePhone Number
Text Messaging

Yes, I agree to receive text messages from the Senate Office regarding time sensitive informationNo, please do not send text messages
Home Email
example@example.com
1st Committee Choice*
2nd Committee Choice*
Should be Empty:

Committee Preference Form