New Student Information Form
DIRECTIONS
1. All students must complete this New Student Information Form.
2. All students must apply for housing and make their $200 enrollment deposit online at
3. If you prefer to pay your $200 enrollment deposit by check or money order, please make it payable to Pacific Lutheran University and enclose
it with this form. Refunds of the enrollment deposit will not be granted after May 1 for full admission and January 1 for spring admission.
Status (Check one in each column)
Student’s Name __________________________________________________________________________________________________________
Last Name
First Name
MI
o First Year
o Female
Student’s Permanent Address ________________________________________________________________________________________________
o Transfer
o Male
PLU ID # ______________________________________ Date of Birth ___________________________ Term of Entry _________________________
Parent or Guardian Address(es):
Parents or guardians of current students are considered members of PLU’s Parents Association and will receive copies of Pacific Lutheran University
Scene and information on the Parents Association and other PLU events. We realize this may include more than one household/address. Please
complete all sections that are pertinent. Thank you!
Household 1 o Father o Mother o Stepfather o Stepmother o Other _______________
o Father o Mother o Stepfather o Stepmother o Other _____________
______________________________________________________________________
_____________________________________________________________________
Last Name
First Name
MI
Last Name
First Name
MI
Street Address ____________________________________________________________________________________________________________________________________________
City ________________________________ State __________________ Zip _________________ Country ____________________________ Phone _________________________________
E-mail Address ________________________________________________ Check if preferred o
E-mail Address ____________________________________________ Check if preferred o
Work E-mail _________________________________________________ Check if preferred o
Work E-mail _____________________________________________ Check if preferred o
Employer ____________________________________________________________________
Employer ________________________________________________________________
Title ___________________________________________ Phone _______________________
Title ___________________________________________ Phone ___________________
Employer Address _____________________________________________________________
Employer Address _________________________________________________________
City ______________________________________ State ____________ Zip ______________
City ___________________________________ State ____________ Zip ______________
Household 2 o Father o Mother o Stepfather o Stepmother o Other _______________
o Father o Mother o Stepfather o Stepmother o Other _____________
______________________________________________________________________
_____________________________________________________________________
Last Name
First Name
MI
Last Name
First Name
MI
Street Address ____________________________________________________________________________________________________________________________________________
City ________________________________ State __________________ Zip _________________ Country ____________________________ Phone _________________________________
E-mail Address ________________________________________________ Check if preferred o
E-mail Address ____________________________________________ Check if preferred o
Work E-mail _________________________________________________ Check if preferred o
Work E-mail ______________________________________________ Check if preferred o
Employer ____________________________________________________________________
Employer ________________________________________________________________
Title ___________________________________________ Phone _______________________
Title ___________________________________________ Phone ___________________
Employer Address _____________________________________________________________
Employer Address _________________________________________________________
City ______________________________________ State ____________ Zip ______________
City ___________________________________ State ____________ Zip ______________
Siblings -
M/F
Name
Birth Date
M/F
Name
Birth Date
____
_________________________________________
________________
____
_________________________________________
____________________
____
_________________________________________
________________
____
_________________________________________
____________________
Family members who have attended PLU (indicate name, class year and relationship) ___________________________________________________________________________________________
Church Preference (optional) ______________________________________________________________ If Lutheran, which synod __________________________________________________
Rev 04/14