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UCR Parent Contact Form

The Parent Contact Form provides the basic information on how best to contact you by mail and/or by phone. Please note, all information is kept in confidence for use in official university business only. For questions regarding this "Parent Contact Form", please call (951) 827-2773. Thank you for your assistance.

Student(s) Name:

Please complete for all students who have been admitted and other students currently attending UCR

     
1) First
Middle
Last
Gender
M F
Year Admitted
Date of Birth
/ / 		Major
Social Security Number (For internal use only)
 		Student ID
Check if the student is transferring from another college/university.
2) First
Middle
Last
Gender
M F
Year Admitted
Date of Birth
/ / 		Major
Social Security Number (For internal use only)
 		Student ID
Check if the student is transferring from another college/university.
3) First
Middle
Last
Gender
M F
Year Admitted
Date of Birth
/ / 		Major
Social Security Number (For internal use only)
 		Student ID
Check if the student is transferring from another college/university.
 
 
Father/Guardian:

Residence and Business Information (if applicable)

     
Dr./Mr.
First
Middle
Last
Street Address
City
State
Zip
Home Phone
( ) 		Company Name/Employer
Work Phone
( ) 		Job Title
Home Email
 		Business Email
Preferred Language (Other than English)
 
 
Mother/Guardian:

Residence (if different from father) and Business Information (if applicable)

     
Dr./Mrs./Ms.
 		First
Middle
Last
Street Address
City
State
Zip
Home Phone
( ) 		Company Name/Employer
Work Phone
( ) 		Job Title
Home Email
 		Business Email
Preferred Language (Other than English)
 
 
I am (We are) interested in:      
Check all that apply:
 
Legislative Advocacy
Spring Recruitment Events
Scholarship Selection
Parent of the Year Committee
For more information on how to be involved with our UCR Parents Association please call (951) 827-4511 or visit http://www.alumni.ucr.edu/involved/parents.html
 
 
 

For questions regarding this form please call Advancement Services at (951) 827-2773 or email us at biodata@ucr.edu


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Copyright 2004, Regents UC.
Last updated: 7/30/2004.
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