Family Information Form

Thank you for filling out the WPI Family Information Form. All of the information you provide is voluntary and will be used only for communication and other internal purposes of WPI. (Read our Privacy statement for more information.)

If you prefer, you can download a PDF version of this form and mail it to WPI, Office of Development and Alumni Relations, Attn: Patrick T. Maloney, 100 Institute Road, Worcester, MA, 01609-2280.

For additional assistance, please contact us at mykidis@wpi.edu or call 1-877-974-3863.

* Denotes a required field

Student

Full name *
Suffix
Student ID number
Date of birth *
Class year *
Home address (street) *
City *
State *
ZIP *
Home phone *
Student's secondary school(s) attended during last three years
Hometown newspaper

for announcements of achievements, honors, graduation news, etc.

Guardian 1

Please check all that apply * Parent
Stepparent
Nonparent Guardian
Male
Female
Single
Married
Separated
Divorced
Remarried
Widowed
Prefix
Name *
Suffix
Home address (street) *
Email address *
City *
State *
ZIP *
Home phone *
College attended
Degree
Class year
Additional education
Degree(s)
Job title *
Company *
Business address (street)
City
State
ZIP
Business phone
Professional, civic, social affiliations
Volunteer Opportunities * Yes, I am interested in volunteer opportunities at WPI
No, I am not interested in volunteer opportunities at WPI
Does your company match charitable giving? Yes
No

Guardian 2

Please check all that apply Parent
Stepparent
Nonparent Guardian
Male
Female
Single
Married
Separated
Divorced
Remarried
Widowed
Prefix
Name
Suffix
Home address (street)
Email address
City
State
ZIP
Home phone
College attended
Degree
Class year
Additional education
Degree(s)
Job title
Company
Business address (street)
City
State
ZIP
Business phone
Professional, civic, social affiliations
Volunteer Opportunities Yes, I am interested in volunteer opportunities at WPI
No, I am not interested in volunteer opportunities at WPI
Does your company match charitable giving? Yes
No

Siblings

Name
Suffix
Birthdate
Relationship
School(s) attended

Name
Suffix
Birthdate
Relationship
School(s) attended

Name
Suffix
Birthdate
Relationship
School(s) attended

Relatives

who have attended WPI and/or WPI graduate programs

Prefix
Name
Suffix
Relationship
Class Year
Graduate program

Prefix
Name
Suffix
Relationship
Class year
Graduate program

Additional Family Members

You may sign up additional family members—grandparents, etc.—to receive communications from WPI.

Prefix
Name
Suffix
Home address (street)
Email address
City
State
ZIP
Home phone
College attended
Degree
Class year
Additional education
Degree(s)
Job title
Company
Business address (street)
City
State
ZIP
Business phone
Professional, civic, social affiliations

Prefix
Name
Suffix
Home address (street)
Email address
City
State
ZIP
Home phone
College attended
Degree
Class year
Additional education
Degree(s)
Job title
Company
Business address (street)
City
State
ZIP
Business phone
Professional, civic, social affiliations
Type in the following two words
 
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Last modified: August 29, 2008 10:10:19