EduPlan Student and Family Contact Form

Student and Family Contact Data
Dear Student/Parents:

Thank you for your interest in EduPlan. Please use this form to provide information and allow us to send you further details regarding our services.

This data is requested solely for the purpose of communicating with you. We do not sell or distribute your information.

If you have any questions, please do not hesitate to contact us at info@eduplan.us.

We look forward to getting in touch with you soon.

Warmest regards,

Claudine Vainrub, EduPlan

Student and Family Contact Data
Student Name*

First NameLast Name
Student Email*
example@example.com
Student Mobile Number
If not in the U.S., please include the country area code.
Student Home Number
If not in the U.S., please include the country area code.
Parent Record Type ID
Parent 1 Name*

First NameLast Name
Parent 1 Email*
example@example.com
Parent 1 Mobile Number
If not in the U.S., please include the country area code.
Parent 2 Name

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Mobile Number
If not in the U.S., please include the country area code.
EduPlan Services of Interest
Please choose your grade or education status. If you are an international student, please list grade level by the number and not by the name. For example, if you are in 10th grade, select 10th grade even though you might not be a sophomore student. If you are attending a university, you are a "College or University student.
Name of High School (Attending or Attended)
Please choose your grade or education status. If you are an international student, please list grade level by the number and not by the name. For example, if you are in 10th grade, select 10th grade even though you might not be a sophomore student. If you are attending a university, you are a "College or University student.
High School Graduation Year (expected or completed)
Name of College or University, or Graduate School Programs (Attending or Attended)
Only if student already graduated from high school. If you have not, please leave this field blank.
Student Date of Birth*

MonthDayYear
Month / Day / Year
Student Country of Birth
Current Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Preferred Language
How did you hear about EduPlan?
Any Special Comments or Additional Information?
Add me to your mailing list (required for new EduPlan students)*

Yes!No
Should be Empty:

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Student and Family Contact Data

Student and Family Contact Data