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Parent Program E-Newsletter Sign-up Form

Please provide us with your contact information so we may send you parent newsletters and involve you in our programs and services. All information contained in your answers will be handled with respect for your privacy by Cal Poly and will not be distributed beyond the University community.

* Asterisk Denotes Required Field

Student(s)

* First Name :
Middle Initial/Name :
* Last Name :
* Last 4 Digits of SSN :
* Gender : Male Female
* Birth Date :
* Enrollment status : Prospective student Currently enrolled Alum

Additional Student

First Name :
Middle Initial/Name :
Last Name :
Last 4 Digits of SSN :
Gender : Male Female
Birth Date :
Enrollment status : Prospective student Currently enrolled Alum

Additional Student

First Name :
Middle Initial/Name :
Last Name
Last 4 Digits of SSN :
Gender : Male Female
Birth Date :
Enrollment status : Prospective student Currently enrolled Alum

Parents and Supporters

Relative One

* Relationship :
* Gender : Male Female
Prefix :
* First Name :
Middle Initial/Name :
* Last Name :
Suffix
* E-mail Address :
Please Confirm Your E-mail Address:

Before clicking submit, please verify that your E-mail address is correct.

I'm a Cal Poly Alum
Degree Year/Major :

Preferred Address and Phone Number

Use same address and phone number for both relatives

* Address Type :
* Address Line 1 :
Address Line 2
* City :
* State/Province :
Region (non-U.S./Canadian)
* Country
* CountryZip/Postal Code :
* Phone : XXX-XXX-XXXX

Relative Two

Relationship :
Gender : Male Female
Prefix :
First Name :
Middle Initial/Name :
Last Name :
Suffix
E-mail Address:
Please Confirm Your Email Address :

Before clicking submit, please verify that your E-mail address is correct.

I'm a Cal Poly Alum
Degree Year/Major :

Preferred Address and Phone Number

Address Type :
Address Line 1 :
Address Line 2
City :
State/Province :
Region (non-U.S./Canadian)
Country
Zip/Postal Code :
Phone : XXX-XXX-XXXX