Parents and Guardian Contact Form

Parent/Guardian

name

first name last name

email

occupation

Additional Parent/Guardian

If a second parent/guardian lives with you, you can add their information here. They can also complete this form themselves.

name

first name last name

email

occupation

address

address line 1
address line 2
city
state
zip

phone

Your Student

student name

first name last name

Your Preferences

Are you interested in serving on the Parent's Council?
yes  no

If yes, which of the following areas interest you? ( check all that apply)
Communication
Enrollment
Philanthropy

What information would you like to receive from us throughout the year? (check all that apply)
Information about campus events
Tips for Parenting a College Student
Updates on Personnel Changes
Updates on Changes to Curriculum
Updates on Centenary Athletics
Information on Student Achievements
Other (please specify: )

Verify That You Are Human

By re-typing two words in the "reCaptcha" box below, you help us to maintain the security of this form. If you have difficulty making out the words in question, use the refresh button to get new words.

Visually impaired users can utilize the audio link to receive an audio cue.

If it seems like you can't see a box in which to type the two words, or if something is weird about that box, then

 

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