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College Student Information is shared with Our Savior Lutheran Church and WELS Campus Ministry (copy)

Last name
First Name
Initial
E-mail Address
Is this e-mail address valid only during the school year or year round?*
If you have a second e-mail address, please list
Current Date
Home Church
Home Church City, State, Zip
School Year*
Gender*
Date of Birth*
Your Home Address*
City, State, Zip*
Home Phone*
Do you live with your parents when college is in session?*
Please check:*
Name of University/College*
City, State, Zip*
Tentative Graduation Date (month/year)*
Major/Program*
Mailing Address @ School; include apartment number*
City, State, Zip*
Phone Number @ School, include area code*
Do you normally go home for the summer or stay at school?
Is this a cell phone number?*
If you have another number @ school (e.g. cell phone) please list
Send me Meditations, a 3 minute daily devotion book
Send me Forward in Christ, short, easy-to-read format keeps you in touch with WELS news


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