UC Irvine | Parent Information Form

Student's Information Student ID: *
First Name: *
Last Name: *
Birthdate: *
Gender: *

Parents' Information
  Parent 1 Parent 2
Relation to Student:*
Title: *
First Name: *
Middle Name:
Last Name: *
Suffix:
Birth Name:
(if different)    
Deceased:
Marital Status:
UCI Degree:
UCI Degree Year:
Other College Attended:
Language at home:

Parents' Preferred Addresss
Parent 1 Parent 2
 

Parents' Home Addresses
  Parent 1 Parent 2
    parent 1
Street:*
City:*
State/County/Region/Province:*
Postal/Zip Code:*
Country:*
Phone:*
E-mail address:*
Parents' Business Addresses
  Parent 1 Parent 2
Company Name:
Job Title
Street:
City:
State/County/Region/Province:
Postal/Zip Code:
Country:
Phone:
E-mail address:
Do you have any children who attended or are attending UCI?
Child 1 Child 2 Child 3
First Name :
Middle Name :
Last Name :
Birthdate:
Graduation Year:




UCI Parent's Program
Inquiries: (949) 824-0542 | Fax:(949) 824-3890
E-mail: carin.rodgers@uci.edu