Parent Information Form

Please list parents, guardians, grandparents or other family members who would like to receive the Concordia University magazine and invitations to family events.

Required fields are highlighted with a .

Student Information

Student First Name

Student Middle Initial

Student Last Name

Other Name/s on Academic Records

Is either parent a full-time employee of Concordia University Portland?

Name of your parent if you select yes above

Parent/Guardian #1 Information

Relationship to Student

Title

First Name

Middle Initial

Last Name

Preferred First

Street Line 1

Stree Line 2

City

State

Zip

Home Phone

Cell Phone

Work Phone

Email Address

College, if any

Company

Occupation/Title

Church Membership

Concordia alum?

What year if you select yes above?

Click here to add one more parent/guardian information

Relationship to Student

Title

First Name

Middle Initial

Last Name

Preferred First

Street Line 1

Stree Line 2

City

State

Zip

Home Phone

Cell Phone

Work Phone

Email Address

College, if any

Company

Occupation/Title

Church Membership

Concordia alum?

What year if you select yes above?

Click here to add grandparents or other family members

First Name

Last Name

Street Line

City

State

Zip

Relationshp to Student

Concordia alum?

What year if you select yes above?

Click here to add one more grandparents or other family members

First Name

Last Name

Street Line

City

State

Zip

Relationshp to Student

Concordia alum?

What year if you select yes above?

Concordia University, Portland

Parent Information Form

Student Information

Parent/Guardian #1 Information

Click here to add one more parent/guardian information

Click here to add grandparents or other family members

Click here to add one more grandparents or other family members