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Students at the launch of the Stanford Chapter

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"We cannot always build the future for our youth, but we can build our youth for the future."

— Franklin Roosevelt 


 

Attendee Registration


Your name:

Your email:

Recipient's name:

Recipient's email:

Message:

To prevent spam, please enter the first letter of the recipient's email and the first letter of the recipient's name in the box below (for example, if the name is "John Doe" and the email is "bigjohn@johndoe.com", you would enter "jb"):

Use the form below to register your intent to attend the conference. After submission, a Roosevelt Fellow from Yale will contact you to finalize your reservation and assist with your plans for travel and accommodation.

A limited amount of financial assistance for travel costs is available via application. More information will be made available to you after registration, so please do not let financial concerns prevent you from registering for the conference. If you are currently a student, you will be housed with Roosevelt Fellows from the Yale Chapter for Friday and, if desired, Saturday night at no cost.

If you have any further questions, please do not hesitate to contact Jessica G Zvara.

Basic Information

First Name*:

Last Name*:

College/University*:

Student status:
Undergraduate
Graduate
PhD Candidate

Anticipated year of graduation (XXXX):

Major(s):

Organization (non-Roosevelt students)*:


Contact Information

Mailing street address:

Mailing city/state/zip:

Summer mailing address*:

Summer city/state/zip*:

Phone number (XXX-XXX-XXXX)*:

Fax number (XXX-XXX-XXXX):

Email address*:

Alternate email address:


Us and You

Describe your involvement with the Roosevelt Institution*:
I'm a member of a registered chapter (a chapter listed on the Roosevelt website)
I was published in a Roosevelt publication
I was published on the Roosevelt website
I want to start a chapter
I want to join my campus's chapter
I'm an advisor to the Roosevelt Institution or one of its chapters
I work for an organization collaborating with the Roosevelt Institution
I'm a donor
I'm interested in donating to the Roosevelt Institution or one of its chapters
I have not been involved but wish to attend the Roosevelt Education Conference to learn more about the Roosevelt Institution

What is your role in your chapter (Roosevelt members)*:

How did you hear about the Roosevelt Education conference at Yale? (check all that apply)
Through a registered Roosevelt chapter
An organization I work for
My professor
Roosevelt Institution website
A student organization on my campus (other than a Roosevelt chapter)

Other:

Why do you want to attend the Roosevelt Education Conference? What goals do you have for the event? (200 words or fewer)*:

  • denotes a required field