6
V. Family Data
Household
Parents’ Marital Status (relative to each other): Never married _____ Married _____ Widowed _____ Separated _____ Divorced (date ______ /______________ )
If not with both parents, with whom do you make your permanent home? _______________________________________________________________________________________________
Please indicate the names of relatives and friends who are, or were, Wake Forest students:
____________________________________________________________________________________________________________________________________________________________________________
Last (maiden), First, Middle Class Year Relationship
____________________________________________________________________________________________________________________________________________________________________________
Last (maiden), First, Middle Class Year Relationship
____________________________________________________________________________________________________________________________________________________________________________
Last (maiden), First, Middle Class Year Relationship
Parent 1: Mother ______ Father ______ Unknown ______
Is Parent 1 living? Yes _____ No _____ (Date deceased ______ /______________ )
_____________________________________________________________________________________
First Middle Last Title (Mr./Ms./Dr., etc.)
Country of birth ____________________________________________________________________
Home address if different from yours:
_____________________________________________________________________________________
_____________________________________________________________________________________
Home phone (_________) ____________________________________________________________
E-mail _____________________________________________________________________________
Occupation _________________________________________________________________________
Name of employer __________________________________________________________________
College (if any) ____________________________________________________________________
Degree ______________________________________________________ Year _______________
Graduate school (if any) ____________________________________________________________
Degree ______________________________________________________ Year _______________
Legal Guardian: (if other than a parent)
Relationship to you _______________________________________________________________
_____________________________________________________________________________________
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
Home address if different from yours:
_____________________________________________________________________________________
_____________________________________________________________________________________
Home phone (_________) ____________________________________________________________
E-mail _____________________________________________________________________________
Occupation _________________________________________________________________________
Name of employer __________________________________________________________________
College (if any) ____________________________________________________________________
Degree ______________________________________________________ Year _______________
Graduate school (if any) ____________________________________________________________
Degree ______________________________________________________ Year _______________
Parent 2: Mother ______ Father ______ Unknown ______
Is Parent 2 living? Yes _____ No _____ (Date deceased ______ /______________ )
_____________________________________________________________________________________
First Middle Last Title (Mr./Ms./Dr., etc.)
Country of birth ____________________________________________________________________
Home address if different from yours:
_____________________________________________________________________________________
_____________________________________________________________________________________
Home phone (_________) ____________________________________________________________
E-mail _____________________________________________________________________________
Occupation _________________________________________________________________________
Name of employer __________________________________________________________________
College (if any) ____________________________________________________________________
Degree ______________________________________________________ Year _______________
Graduate school (if any) ____________________________________________________________
Degree ______________________________________________________ Year _______________
Siblings:
Please give names and ages of your brothers or sisters. If they have attended
college, give the names of the institutions attended, degrees and approximate dates:
_____________________________________________________________________________________
Name Age Relationship
College Attended __________________________________________________________________
Degree Earned _________________________________________ Year __________________
or Expected yyyy-yyyy
_____________________________________________________________________________________
Name Age Relationship
College Attended __________________________________________________________________
Degree Earned _________________________________________ Year __________________
or Expected yyyy-yyyy
_____________________________________________________________________________________
Name Age Relationship
College Attended __________________________________________________________________
Degree Earned _________________________________________ Year __________________
or Expected yyyy-yyyy