Parent Contact Information

Parent Information Form

Parent Name*

First Name

Last Name

Parent's Email*

Student's Name*

First Name

Last Name

Students anticipated LCC graduation year

Student's Birth Date*

Student's S Number

Parent's Mailing Address

Address Line 1

Address Line 2

City

State

ZIP Code

Parent's Phone

Are you an LCC Alumnus?

Yes No Other

What year did you graduate?

What degree or certificate did you receive?

List any direct family members who are former LCC students.

Do you have any comments or questions?