WSU - Parents Association Membership Form and Information

Application for Membership

Please complete this online registration form and choose a payment option. If you prefer you may print the form and mail it, along with your payment, to the Office of Student Support Services, 022 Student Union, 3640 Colonel Glenn Hwy., Dayton, OH 45435-0001.

Name of Parent (s) / Guardian (s):
Address:
City/State/Zip:
Home telephone number:
Business telephone number:
(1)Student's Name:
Birth date (mm/dd/yyyy):
Expected date of graduation (mm/yyyy):
(2)Student's Name:
Birth date (mm/dd/yyyy):
Expected date of graduation (mm/yyyy):
Please Check one:	New Membership Renewal
Please send information about the Parent Advisory Council, the governing board of the Association. May we send you future information by e-mail? Yes No
E-mail address:

Please choose one payment option:

	I will mail a check for $25 payable to "WSU Parents Association", to the Office of Student Support Services, 022 Student Union, 3640 Colonel Glenn Hwy., Dayton, OH 45435-0001.
	I will call the Office of Student Support Services at (937) 775-3749 between 8:30 a.m. and 5:00 p.m. to give my credit card payment information.

WSU Parents Association Endowed Scholarship Fund

The WSU Parents Association is sponsoring the establishment of an endowed scholarship fund. If you would like to make a tax-deductible contribution, please write separate checks for your membership and the scholarship fund. Make your scholarship contribution payable to Wright State University Foundation.

I would like to make a tax-deductible contribution toward the endowed Parents Association Scholarship Fund.

Endowed Scholarship fund (make payments by check only)

$10

$25

$50

$100

Other

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