Parent Data Request Form

Name *

Spouse Name

Student Name *

Select *Relationship to StudentMotherFatherGuardianGrandparent

Select *My Student is a(n)Current StudentProspective StudentAccepted Student

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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Phone

Email Address *

SelectI would like to receive email updates:YesNo

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giving to Pfeiffer Universityvolunteering at an on-campus eventhosting a parents and families event in my arearecruiting/referring prospective Pfeiffer studentgetting other parents involvedspeaking at my church/other local organization

I am interested in becoming more involved in my student’s educational experience by:

Please…update my emergency contact infotell me about upcoming Pfeiffer eventscontact me regarding the Parents and Families Fund

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