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Home › Campus Life › First-Year Program › Parent/Guardian Contact Information

Please fill out the form below as completely as possible for one or more parents/guardians of your Augustana student.

Student Name (First and Last): *

Parent/Guardian 1 Information

First Name: *

Last Name: *

Email address 1: *

Email address 2:

Please include area code in phone numbers below.

Mobile Phone:

Mobile Phone 2:

Home Phone:

Work Phone:

Please indicate which phone you consider your primary line.:

Mobile

Home

Work

Parent/Guardian 2 Information

First Name:

Last Name:

Email address 1:

Email address 2:

Please include area code in phone numbers below.

Mobile Phone:

Mobile Phone 2:

Home Phone:

Work Phone:

Please indicate which phone you consider your primary line.:

Mobile

Home

Work

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2001 S. Summit Avenue, Sioux Falls, SD 57197 | 800.727.2844 | 605.274.0770 | +001 605.274.5516 (outside the United States)

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