Clark University Alumni & Friends
950 Main Street • Worcester, MA 01610
Tel: 508 793 7166 • alumni@clarku.edu

Advancement
Parent

Parents Association sign-up form

Parent 1

 

Parent 2

(Select One)*
Mr  Mrs   Ms Dr  		  (Select One)
Mr  Mrs   Ms Dr.
*First Name    First Name   
Middle Initial    Middle Initial   
*Last Name   Last Name  
*Address    Address   
Apt.#   Apt.#  
*City   City  
*State  
(enter n/a if outside of US)		 State  
(enter n/a if outside of US)
*Zip or Postal Code  Zip or Postal Code 
Country   Country  
 *Home Phone    Home Phone  
Cell Phone Cell Phone
Work Phone Work Phone
*E-mail   E-mail  
Best time to be reached Best time to be reached
Did you attend Clark? Clark class of: Did you attend Clark? Clark class of:
Parents Date of Birth Month
Day 
Year 		 Parents Date of Birth Month
Day 
Year 
Employer Employer
Postion1 Position2
#Children In College   
*Students First Name 
*Students Last Name
*Students Class Year

How would you like to volunteer your support to Clark?  

Please indicate your interests
Provide career mentoring to students Act as Parent Liaison to local high schools
Recruit students for internships/jobs Make a gift to the Clark Fund
Host Clark event (home or work) House staff visiting area for regional events
Plan events with staff (Move-In-Day, Family Weekend/Homecoming, etc.)    
Question 1: 
Preferred hobby activities
Question  2: 
Are you affiliated with other organizations or committees?
Question 3: 
How can the Parents Association Committee make your Clark experience better?

 

PLEASE CLICK ON THE BUTTON BELOW TO SUBMIT 
YOUR REQUEST

Thank you for your time and consideration!