University Relations Student Information Form


Please provide the following information for Clarion University student publicity:

First Name
Last Name
Class Year Freshman Sophomore Junior Senior
Street Address
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
E-mail
Mother's/Guardian Name
Father's/Guardian  Name
Address (if different)
E-mail
Name and Location of High School
                               Year Graduated
Name and town of hometown newspaper likely to print information about you

Clarion University of Pennsylvania, University Relations.
Copyright © 2006 Clarion University. All rights reserved.
Revised: 06/25/06