New Students

Parent Information Form

Please submit this form no later than Friday, January 6, 2012.

Please confer with your parents in submitting this information online, only one submission for both parents per student allowed.

Wagner Student ID #*:
Student First Name*:
Student Last Name*:
Class/Year:

Mother's Information

Title:

Mrs. Ms. Dr. Rev. Other

If other, please specify:

Mother's First Name:

Middle Name:

Mother's Last Name:

Mother is an alumna of Wagner College? Yes No If yes, Maiden Name:

Class/Year:

Marital Status:

Home Address and Phone

Address:
City:		State:
Zip:		Country:
Phone (mandatory for emergency contact)* :		(format:555-555-5555)
Cellular Phone (if applicable, necessary for emergency contact) :		(format:555-555-5555)
Email:

Employment/Business Information

Father's Information

Title:

Mr. Dr. Rev. Other

If other, please specify:

Suffix:

Sr. Jr. II III Other

If other, please specify:

Father's First Name:

Middle Name:

Father's Last Name:

Father is an alumnus of Wagner College? Yes No

Class/Year:

Marital Status:

Home Address and Phone

Address:
City:		State:
Zip:		Country:
Phone (mandatory for emergency contact)* :		(format:555-555-5555)
Cellular Phone (if applicable, necessary for emergency contact) :		(format:555-555-5555)
Email:

Employment/Business Information

Additional Information
Relative(s) that graduated from Wagner College (leave blank if none): (Relationship choices: Grandparent , Brother, Sister, Cousin, Aunt, Uncle) Name: Class Year: Relationship: Name: Class Year: Relationship: Name: Class Year: Relationship: Name: Class Year: Relationship: Name: Class Year: Relationship: Do your parents work for a matching gift company? Mother: Yes No Father: Yes No Are your parents interested in becoming active members of the Parent Association? Yes No Please add my parents to the Parents Association E-Newsletter mailing list: Preferred email: Please add my parents to the Seahawks Athletics Email updates list: Preferred Email: Ways to Volunteer (check all that are of interest to your parents): Speaking to a class Offer student internships Events Mentorship Other: