New Student Parent or Guardian Contact Information

Student Information

First Name*

Last Name*

Email Address*

Student Mailing Address

Country

Street

City

Region

Postal Code

Student's Anticipated Entry Term

Parent Or Guardian Information #1

Relationship to Student

Prefix

First Name

Last Name

Preferred Name

Email Address

Phone Number

Mailing Address

Same as Student Mailing Address

Country

Street

City

Region

Postal Code

Employer

Birthdate

Is this your preferred parent/guardian contact?

Yes

Parent Deceased

Parent Or Guardian Information #2

Relationship

Prefix

First Name

Last Name

Preferred Name

Mailing Address

Same as Student Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Phone Number

Employer

Birthdate

Is this your preferred parent/guardian contact?

Yes

Parent Deceased

The President’s Parents Council is an advisory council comprised of 50+ families who receive access to University administration, invest at the leadership level, receive special invitations and serve as ambassadors for Jacksonville University.

I am interested in learning more about the President's Parents Council

Additional Parent Or Guardian Information

Would you like to add additional parent/ guardian information?

Yes

Relationship

Prefix

First Name

Last Name

Preferred Name

Email Address

Phone Number

Employer

Birthday

Parent Deceased

Family Information

Other children and dates of birth (If JU alum/student, list class year)

Please list any relatives and/or friends affiliated with Jacksonville University and their relationship to the University; e.g. Alumnus, Employee, Trustee, etc.

Would you like to add grandparent information?

Yes

Grandparent First Name

Grandparent Last Name

Grandparent Email

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New Student Parent or Guardian Contact Information

Student Information

Parent Or Guardian Information #1

Parent Or Guardian Information #2

Additional Parent Or Guardian Information

Family Information