EmailMeForm
CUB Updated Contact Information Sheet
Date
MM
/
DD
/
YYYY
Student Name
*
First
Last
Home Address
Street Address
City
State / Province / Region
Postal / Zip Code
Student's Cell Phone
*
###
-
###
-
####
Home Phone
###
-
###
-
####
Student Email Address
*
Parental Information
Mother/Guardian 1 Name
*
First
Last
Cell Phone Number
*
###
-
###
-
####
Work Phone Number
###
-
###
-
####
Mother/Guardian's Email Address
Best way to contact you (check one)?
Cell Phone
Work Phone
Email
Father/Guardian 2 Name
First
Last
Cell Phone Number
###
-
###
-
####
Work Phone Number
###
-
###
-
####
Father/Guardian's Email
Best way to contact you (check one)?
Cell Phone
Work Phone
Email
