Brandeis Junior Preview

Who is filling out this registration form?

Student

Family Member of a Student

School Counselor/IEC

If you are attending with or on behalf of a student, please provide their information as well as your own below.

Student Information

First Name

Preferred Name If you go by another name and wish to share that, please do so! We want to address you by the name with which you feel most comfortable. If you share a preferred name with Brandeis, we will use that name in future communication with you. However, please know that your parent, guardian, or school counselor may see or hear your preferred name. Sharing a preferred name is optional. If you’re worried about someone other than the admissions staff at Brandeis seeing this name, you do not have to share it. You can also contact us at any time to update your preferred name.

Middle Name

Last Name

Email Address

Preferred Pronouns

Birthdate

Mobile Phone Number

Yes

No

College Entry Term (when do you plan to start college)

High School Name

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Counselor Information

Counselor First Name

Counselor Last Name

Counselor Email

Counselor Type

High School

CBO

Independent Counselor

CBO Name

Visit Information

Total Number of Guests (Including Student)

Accessibility Requests

Do you or someone in your party need accommodations, such as mobility assistance or an ASL interpreter?
Please note that Sign Language Interpreter (ASL) Requests require 2 weeks notice)

Yes

No

Please select the type(s) of accommodations needed:

Sign Language Interpreter (ASL)

Physical Accessibility Request

A representative from the Office of Admissions will contact you about your ASL interpreter request within a week.

Please describe the physical accessibility request below so we can best support you during your visit to campus:

Brandeis University Admissions

Brandeis Junior Preview