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Parent & Family Information Form

Contact Information

Relationship to Student

Your First Name

Your Last Name

Your Email Address

Your Cell Phone Number

Would you like to receive text messages from SSU?

Would you like to receive text messages from SSU?

Yes

No

Mailing Address

Mailing Address

Country

Street

City

Region

Postal Code

Are you a graduate of SSU?

Are you a graduate of SSU?

Yes

No

Student Information

Student First Name

Student Last Name

Student Birthdate

Student Birthdate

Student High School Graduation Year