One moment please...
Schools of Medicine and Dentistry and Nursing Registration
Thank you for registering with the Catholic Newman Community at the University of Rochester. You can find the form below. Also, please visit our
website
for more information on Newman's weekly and upcoming activities. You can also reach out to Dr. Carroll below.
Thomas Carroll, M.D., Ph.D., is an Assistant Professor of Medicine at the University of Rochester. He practices both general internal medicine and palliative care in the office and hospital settings. His interests include communication training, medical education at all stages of training, and bioethics. Dr. Carroll also serves as a board member and representative of The Finger Lakes Guild of the Catholic Medical Association, of which Newman is a partner. Please direct any questions about Newman at the Medical Center or the Guild to
thomas_carroll@urmc.rochester.edu
.
Contact Information
Name:
*
First Name
Last Name
Address:
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email:
*
Verify Email
*
Mobile Phone:
###-###-####
Birthdate:
(mm/dd/yyyy)
Academic Information
May we occasionally text you?
*
Yes
No
Are you an international student?
*
Yes
No
What is your country of origin?
Affiliation:
*
select one
Intern
Faculty/Staff Member
Fellow
Graduate Student
Resident
Undergraduate Student
Class Year:
Major(s):
Minor(s):
Specialty(ies)/Graduate Program(s):
Department:
If other, please explain.
Activities/Interests
Adoration
Alternative Spring Break
Becoming Catholic/Confirmed
Big Newman, Little Newman
Catechesis
Graduate and Young Professionals Group
Intramural Sports
Lectures
Music Ministry/Choir
Reconciliation
Retreats
Rosary Group
Service Opportunities
Social Events
If other, please explain.
Parent Contact Information
Only fill out this section if you are an undergraduate student.
Parent/Guardian #1 Name:
First Name
Last Name
Is your first parent/guardian's address the same as yours?
Only fill out the below address form if your first parent/guardian's address is different from yours.
Yes
No
Parent/Guardian #1 Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Parent/Guardian #1 Email:
Verify Email
Parent/Guardian #1 Mobile Phone:
Parent/Guardian #2 Name:
First Name
Last Name
Is your second parent/guardian's address the same as yours?
Only fill out the below address form if your second parent/guardian's address is different from yours.
Yes
No
Parent/Guardian #2 Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Parent/Guardian #2 Email:
Verify Email
Parent/Guardian #2 Mobile Phone:
Home Parish Information
Only fill out this section if you are an undergraduate student. Please fill in as much information as you know.
Parish Name:
First Name
Last Name
Pastor/Pastoral Administrator's Name:
First Name
Last Name
Parish Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country