Student Parent Association (S.P.A.) Membership Form

If for any reason you would prefer to download the form and submit it via e-mail to Women’s Center Service account at womenctr@louisville.edu and/or to Phyllis M. Webb, phyllis.webb@louisville.edu, you may do that here.

Name First & Last

Birthday mo/dd/yr

Local Address Street, City, State

Zip Code

Phone Number

Best time to call

AM
PM

Your E-Mail Address

Ethnicity

Gender

Female
Male

Single Parent?

Yes
No

Student Association

U of L Student
JCTCS Student
Other University/College

Classification

U of L Alumni Student-Parent
Undergraduate
Graduate Student

Major

Minor

Expected Graduation Date/Completion

Partner Name First & Last

Birthday mo/dd/yr

Local Address Street, City, State

Zip Code

Phone Number

E-Mail Address

Ethnicity

Gender

Female
Male

Student Association

U of L Student
JCTCS Student
Other University/College

Classification

U of L Alumni Student-Parent
Undergraduate
Graduate Student

Major

Minor

Child Name

Birthday mo/dd/yr

Gender

Frmale
Male

What do you hope to accomplish by taking part in this group?

What would help you succeed as a student parent?

What are some areas that you would like to improve in as a student and/or parent?

Please provide suggestions of topics for meetings and family activities. What would you like to learn more about and what does your family enjoy doing together?

Please enter the text below:

Women's Center

Student Parent Association (S.P.A.) Membership Form