Richmond Home

Family Data Form

Thank you for filling out the Family Data Form. We use this form to find ways to connect our families to the University of Richmond experience.

Student Information

Student Information

Name: First: Middle: Last:
Nickname:  
Address: Street Address: City: State:
  Zip Code: Country:
High School    
Expected Year of College Graduation: 2017
2018
2019
Parent Status: Married
Divorced
Separated
Single
Widowed
Other
Do you have siblings? Yes   No    
If “Yes”, please provide names and ages:    
Name: Age:
Name: Age:
Name: Age:
Name: Age:
Father/Guardian Information

Father/Guardian Information

Name: First: Middle: Last:
Nickname:  
  Living
Deceased
   
Is home address same as students? Yes No
If yes, skip down to Preferred Email. If no, please fill out.
Address: Street Address: City: State:
  Zip Code: Country:
Phone Number: Phone Type: Home   Cell
Preferred Email:    
Business Information:
Business Name:
Business Title:
Address: Street Address: City: State:
  Zip Code: Country:
Phone Number:    
Email:    

Educational Information:

Names of colleges/graduate/professional schools attended, degrees earned and associated year it was earned (if any):
School Name: Degree:  Year: 
School Name: Degree:  Year: 
School Name: Degree:  Year: 

Philanthropic, Community, Corporate, Foundation or Civic Board positions:

Please include all current and former positions and/or involvement.

Mother/Guardian Information

Mother/Guardian Information

Name: First: Maiden: Last:
Nickname:  
  Living
Deceased
   
Is home address same as students? Yes No
If yes, skip down to Preferred Email. if no, please fill out.
Address: Street Address: City: State:
  Zip Code: Country:
Phone Number: Phone Type: Home   Cell
Preferred Email:    
Business Information:
Business Name:
Business Title:
Address: Street Address: City: State:
  Zip Code: Country:
Phone Number:    
Email:    

Educational Information:

Names of colleges/graduate/professional schools attended, degrees earned and associated year it was earned (if any):
School Name: Degree:  Year: 
School Name: Degree:  Year: 
School Name: Degree:  Year: 

Philanthropic, Community, Corporate, Foundation or Civic Board positions:

Please include all current and former positions and/or involvement.

Step-Father Information

Step-Father Information

Name: First: Middle: Last:
Nickname:  
Phone Number: Phone Type: Home   Cell
Preferred Email:    
Step-Mother Information

Step-Mother Information

Name: First: Maiden: Last:
Nickname:  
Phone Number: Phone Type: Home   Cell
Preferred Email:    
Additional Address Information

Additional Address Information

We host events all throughout the country so if you or your family spends time at another location, please let us know.

  1. Address: Street Address: City: State:
      Zip Code: Country:
  2. Address: Street Address: City: State:
      Zip Code: Country:

Form Deadline: June 1

Questions About This Form

If you have questions about this form, please contact Ms. Becky McKinney through email or at (804) 289-8487.