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Family Information Form

New Student Information


Last Name:
	Required Field
First Name:
	Required Field
Middle Name:
Title:
Suffix:
Preferred/Nickname:
This student is your:
	Required Field
Gender:	Male Female

Parent Information

	Parent One	Parent Two
		Spouse: Yes No
Relationship to student:
	Required Field
Title:
Last Name:
	Required Field
First Name:
	Required Field
Middle Name:
Suffix:
Preferred/Nickname:
	Male Female	Male Female
Email:
Phone One:
	example:(xxx)xxx-xxxx	example:(xxx)xxx-xxxx
Phone Two:
Preferred Phone:	Home Cell	Home Cell

Parent Home Address


Apt/House/Street:
	Required Field
City:
	Required Field
State:
	Required Field
Zip/Postal code:
Country:
	Required Field
Preferred Address:	Home Business	Home Business

Parent Business Information

Employer:
Title:
Business Phone:
	example:(xxx)xxx-xxxx	example:(xxx)xxx-xxxx
Business Email:

Parent Academic Information

	Parent One	Parent Two
College:
Degree:
Year:

Contact Preference

Please check all that apply.	Email Mail Phone	Email Mail Phone

Current Community or Professional Activities, Boards and Membership

	Parent One	Parent Two
Organization 1:
Role:
Organization 2:
Role:
Organization 3:
Role:

Family members who have attended the College of Charleston

	Family Member One	Family Member Two
Relationship to student:
Title:
Last Name:
First Name:
Middle Name:
Years of attendance from:
Years of attendance to:

Additional Family Information

	Maternal Grandparents	Paternal Grandparents
Last Name:
First Name:
Middle Name:
Suffix:
Phone:
	example:(xxx)xxx-xxxx	example:(xxx)xxx-xxxx