New Student Information Form printable pdf download

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

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

Last Name

First Name

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

Last Name

First Name

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