WASHINGTON AND LEE UNIVERSITY

FAMILY INFORMATION FORM

Please complete form by June 30

Student's Complete Name
Student's Preferred Name
High School Attended

	FATHER	MOTHER
Complete Name
Preferred Name
Preferred Prefix	Mr. Dr.	Mrs. Ms. Dr.
Home Address
Home Phone
E-mail Address
Professional Field
Title
Business Name
Address
Work Phone
College(s) & Degree(s)
Community, Corporate, Foundation or Civic Involvement

Are you willing to become a career mentor for current Washington and Lee students?
	Yes No	Yes No

Marital status	Married Separated Divorced
Do you prefer correspondence at	Home Business
Other relatives who attend(ed) W&L

GRANDPARENTS
	PATERNAL	MATERNAL
Name
Address

SIBLINGS
Name	Age	Attended/ing College?	If yes, where?
		Yes No
		Yes No
		Yes No
		Yes No
		Yes No
		Yes No
		Yes No

	STEP-FATHER (if applicable)	STEP-MOTHER (if applicable)
Complete Name
Preferred Name
Preferred Prefix	Mr. Dr.	Mrs. Ms. Dr.
Home Address
Home Phone
E-mail Address
Professional Field
Title
Business Name
Address
Work Phone
College(s) & Degree(s)
Community, Corporate, Foundation or Civic Involvement

Are you willing to become a career mentor for current Washington and Lee students?
	Yes No	Yes No