Family and Parent Update Form

	Update My Contact Information Families Count at CSU Dominguez Hills! Family and Parent Update Form
	Stay Connected! If you are a CSU Dominguez Hills family or parent, please help us keep your contact information current by filling out the form below.

* = Required field

Student Information

Student First Name*
Student Last Name*
Student ID
Student Date of Birth *	(MM/DD/YYYY)

Parent & Family Information

Relationship *
Prefix
First Name*
Middle Name
Last Name*

Date of Birth *	(MM/DD/YYYY)
Street Address 1 *
Street Address 2
City *
State *	Zip: *
Country
Home Phone	() -
Cell Phone	() -
Email *

Spouse's First Name
Spouse's Last Name
Is spouse a CSUDH Alum?	Yes No

Parent & Family Education Information

I am CSUDH Alumni	YesNo
Please check this box if your name was different while attending CSUDH
Degree/Credential 1
Major 1
Grad Year 1	(Spring 2009)
Degree/Credential 2
Major 2
Grad Year 2	(Spring 2009)

Parent & Family Employment Information

Employer
Title
Street Address 1
Street Address 2
City
State	Zip:
Country
Business Phone	() -
Business Fax	() -
	Submit Reset

If you have questions or need help on this form, please contact the IT Help Desk at (310) 243 - 2500 or via e-mail at helpdesk@csudh.edu or submit your help web ticket here.