Parent Contact Information

First Name     

Middle Name/Initial 

Last Name   

Student ID or Last 4 SSN   

E-mail Address   

Daytime Phone   ext.     

Program You Plan to Pursue  Select OneUndergraduateMSAOther Graduate  

Student or Alumnus Information

Qualifying Student or Alumnus Name While At CMU   

Student ID or Last 4 SSN   

Status  Select OneCurrent StudentAlumnus  

How did you hear about this rate?  Select OneWeb SiteWord of MouthE-flyerMailEventNewspaperMagazineNot SureOther  

If "Other", please specify 

Terms and Conditions

• The information listed above is true and complete to the best of my knowledge.
• I understand that falsification of information or failure to provide supporting documentation, if requested, may result in the revocation of the Parent Tuition Rate as applied to me.
• I understand that if the Parent Tuition Rate is revoked due to my having provided false information, then I will be responsible for paying the full tuition rate, including for those credits previously granted the Parent Tuition Rate.
• I understand that if the Parent Tuition Rate is revoked due to my failure to provide supporting documentation as requested, then I will be responsible for paying the full tuition rate, including for those credits previously granted the Parent Tuition Rate.
• I understand that I must meet all eligibility requirements based on the terms of the Parent Tuition Rate.
• I understand that I am financially responsible and promise to pay the tuition at the full tuition rate if for any reason it is determined that I do not meet the eligibility requirements based on the terms and conditions of the Parent Tuition Rate.

I have read and agree to the above terms and conditions.