Rutgers University Senate

Committee Preference Form
Name *

First Name Last Name
Net ID *
Senator Type

Faculty PTL-Faculty Student Staff Alumni Administrator
Unit Representing
Email *
example@example.com
Campus Address

Campus Address

Room/Suite #

Campus
Campus Phone

Area Code Phone Number
Campus Fax

Area Code Phone Number
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Number

Area Code Phone Number
Text Messaging

Yes, I agree to receive text messages from the Senate Office regarding time sensitive information No, please do not send text messages
Home Email
example@example.com
1st Committee Choice *
2nd Committee Choice *
Should be Empty:

Committee Preference Form