Willamette University

Parents

Matriculation Form

Student Information

First Name:
Middle Name:
Last Name:
Gender: Male
Female
Street Address:
City:
State:
Zip:
Phone:
Date of Birth:
High School:
Type of High School: Public
Private
The student is: New
Transfer

Father Information

First Name:
Middle Name:
Last Name:
Street:
City:
State:
Zip:
Telephone:
Occupation/Title:
Name of Firm:
Business Address:
City:
State:
Zip:
Phone:
Email:
Preferred Contact: Home
Business
Board Memberships and/or Affiliations:
Civic Involvement:
College(s) Attended/Degree/Year:
Graduate School(s) Attended/Degree/Year:

Mother Information

First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Occupation/Title:
Name of Firm:
Business Address:
City:
State:
Zip:
Phone:
Email:
Preferred Contact: Home
Business
Board Memberships and/or Affiliation:
Civic Involvement:
College(s) Attended/Degree/Year:
Graduate School(s) Attended/Degree/Year:

General Information

Check all that apply:
Grandparents: (Name/Address/Phone/Email)
Grandparent Relationship: Paternal
Maternal
Receive Mailings: Yes
No
Grandparents: (Name/Address/Phone/Email)
Receive Mailings: Yes
No
Are you interested in hearing about volunteer opportunities at Willamette?: Yes
No
Are you planning to attend Willamette's Opening Days?: Yes
No
Are you planning to attend Parents & Family Weekend?: Yes
No