Eureka College New Student Packet 2013-14

Student Programs and Services 300 E. College Ave., Eureka, IL 61530-1500 Name ______________________________________________________________________________ Permanent Address ___________________________________________________________________ City ____________________________________ State __________________ ZIP ________________ Telephone ___________________________________ Cell ___________________________________ Parents’ Information or Other (Required if student is under the age of 21. Spouse, releative, or friend if parents information does not apply.) MOTHER MOTHER FATHER FATHER personaldatadocument Return to: Name _____________________________________ Name _____________________________________ Address:____________________________________ Address:____________________________________ __________________________________________ __________________________________________ (H) ______________________________________ (H) ______________________________________ (O) ______________________________________ (O) ______________________________________ Your grades and billing statement cannot be shared until the following is checked. I consent to share, upon request, the following information with: Financial Statement: Academic Report: Father Only Father Only Mother Only Mother Only Both Parents Both Parents Self Self Other: ____________________________ Other: ____________________________ ___________________________________________________ ______________________________ Signature Date – Continued on back – 13

Eureka College New Student Packet 2013-14 | Page 13