Shenandoah Family Information Form

Thank you for taking the time to complete the Shenandoah Family Information Form. Having the most up-to-date contact information for our students and their loved ones provides for the greatest connection and communication. This survey should take no longer than 5-6 minutes. Thank you.

Please provide parent/guardian contact information below for emergency and general communications. This information is strictly confidential and for use by university officials only.
Student First Name * Required
Student Middle Name
Student Last Name * Required
Suffix
Date of Birth * Required
MM
DD
YYYY
Student ID Number * Required
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 of Shenandoah University? If yes, who?
- Yes
- No
List Family Members
Dependency Status:
- YES; student is claimed on parent(s) taxes.
- NO; Student is NOT claimed on parent(s) taxes.
I will enter information for * Required
- ONE Parent/Guardian/Spouse/Partner
- TWO Parents/Guardians

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 * Required
Preferred Phone * Required
Alternative Phone
Relationship to Student * Required
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.

Parent/Guardian/Spouse/Partner 1