| Mailing
Address |
| Address Location: |
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| Address: |
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| line 2 (optional): |
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| City: |
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| State: |
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| Zip Code: |
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| Province: |
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| Postal Code: |
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| Country: |
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| Postal Code: |
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| Contact Information |
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Though not required, the college requests that you provide either a phone number or an email address in case we need to contact you.
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Format for U.S. phones is ###-###-#### |
| Main Phone: |
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| Second Phone: |
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| Third Phone: |
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| Email: |
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Electronic Consent
(Required)
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This consent applies to statements and financial notifications provided annually and semesterly. You may, at any time, request a paper copy of a notification or statement by contacting the Accounting Department. Withdrawal of consent can be made in writing at Santa Rosa Junior College, Attn: Accounting Office, 1501 Mendocino Ave, Santa Rosa, CA 95401 or Accounting@santarosa.edu. The Accounting Department can be contacted by phone at 707-527-4973. Access to statements and notifications will be emailed to your email address on file, if provided (above), and within your student portal.
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| Preferred First Name |
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This is your FIRST name only as you would like it to appear on the instructor roster. Only enter a value here if your preferred name is different than your official name as entered on your college application.
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| Preferred First Name: |
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