Student's Name: E-mail:

Date Student Started College (Semester, Year):

Prospective Parents    Current Parents    Address Change/Update

Mother's Information

Name: Phone:

Address: City: State: ZIP:

Occupation: Employer: Title:

Spouse Name (if different from Father Information):

Father's Information (leave blank if repeating Mother's Information)

Name: Phone:

Address: City: State: ZIP:

Occupation: Employer: Title:

Spouse Name (if different from Mother Information):

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Would you like to be a part of the Methodist University Parents Advisory Council?   Yes   No