- Shenandoah University

Thank you for taking the time to complete the Shenandoah Family Information Form. The information that you provide helps us know you better and helps us meet the needs of our parent community. Information is used by university officials. This survey should take no longer than 5-6 minutes. Please complete the form by August 1. Thank you.

Please provide parent/guardian contact information below for emergency and general communications.

Student First Name *

Student Middle Name

Student Last Name *

Suffix

Date of birth *

Student ID Number *

Your student ID is located on page 2 of your acceptance letter. The ID is seven numbers. You may have to use a leading “0”.

Please enter a number from 0000000 to 9999999.

Are any of your family members graduates or current students of Shenandoah University? If yes, who?

Yes
No

List Family Members

I will enter information for *

ONE Parent/Guardian/Spouse/Partner
TWO Parents/Guardians

Parent/Guardian/Spouse/Partner 1

Salutation *

First Name *

Please use LEGAL name

Middle Name

Last Name *

Suffix

Preferred Name/Nickname

Gender *

Male
Female

Date of birth

Address *

Street Address City State ZIP Code

This address is *

Home
Business

Relationship to Student *

Cell Phone *

Home Phone

Alternate Phone

E-mail *

Employer

Job Title

Contact Preferences

Mail

Home
Business

Phone

Home
Cell
Business

E-mail

Home
Business

Additional Information

Board or Foundation Involvement, Professional or Community Activities

Click “Next” to enter your emergency contact information.

Parent/Guardian 2

Salutation *

First Name *

Please use LEGAL name

Middle Name

Last Name *

Suffix

Preferred Name/Nickname

Gender *

Male
Female

Date of birth

Address:

Same as Parent/Guardian/Spouse/Partner 1
Different from Parent/Guardian/Spouse/Partner 1

Address *

Street Address City State ZIP Code

This address is *

Home
Business

Relationship to Student *

Cell Phone *

Home Phone

Alternate Phone

E-mail

Employer

Job Title

Contact Preferences

Mail

Home
Business

Phone

Home
Cell
Business

E-mail

Home
Business

Additional Information

Board or Foundation Involvement, Professional or Community Activities

Emergency Contact Information

Primary Emergency Contact: (Parent/Relative/Spouse)

The primary emergency contact information is:

The same as that submitted for Parent/Guardian/Spouse/Partner 1
The same as that submitted for Parent/Guardian 2
is unique

Full Name *

Preferred Phone *

Alternative Phone

Relationship to Student *

Secondary Emergency Contact: (Parent/Relative/Spouse)

The secondary emergency contact information is:

The same as that submitted for Parent/Guardian/Spouse/Partner 1
The same as that submitted for Parent/Guardian 2
is unique

Full Name

Preferred Phone

Alternative Phone

Relationship to Student

Alternate Emergency Contact: (non-family member)

Full Name

Preferred Phone

Alternative Phone

Relationship to Student

Additional Information

For example, provide any additional contact information.

Phone

This field is for validation purposes and should be left unchanged.

Welcome to the Shenandoah University family!

Shenandoah Family Information Form

Please provide parent/guardian contact information below for emergency and general communications.

Parent/Guardian/Spouse/Partner 1

Contact Preferences

Parent/Guardian 2

Contact Preferences

Emergency Contact Information

Primary Emergency Contact: (Parent/Relative/Spouse)

Secondary Emergency Contact: (Parent/Relative/Spouse)

Alternate Emergency Contact: (non-family member)