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Waino Wahtera Center for Student Success

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Parent Contact Information Form

Parent/Guardian Information

Last Name

First Name

Role

Last Name

First Name

Role

Address

City

State

Zip Code

Home Phone

Work Phone (optional)

Cell Phone (optional)

Parent/Guardian Email

Additional Parent/Guardian Email

Student Information

Last Name

First Name

Michigan Tech Email Address

Birthdate

2nd Student Information

Last Name

First Name

Michigan Tech Email Address

Birthdate

3rd Student Information

Last Name

First Name

Michigan Tech Email Address

Birthdate

I am interested in joining ParentNet, the online community for Michigan Tech parents, guardians, and family members. Please sign me up for ParentNet. If this option is selected, you will recieve email notification within two weeks at the address provided above with your ParentNet username, password, and instructions for login.

I am the parent of a first-year student and want to continue to receive the Michigan Tech Magazine. If this option is selected, you will receive the next edition of this magazine when it is released.