Episcopal College Ministry | Student Information

Episcopal Student Center Information Form

*Note: All fields marked with an asterisk (*) are required.

�

*Name:

�

Phone Number:

�

*E-Mail Address:

Birthdate:

Mailing Address:

�

City:

State:

�

Zip Code:

�

Dorm / Apartment Complex:

�

Room / Apt. #

Classification:

�

Major:

�

Musical Instruments you play (if any)

�

Parent's Name:

�

Parent's Phone:

�

Parent's Address:

�

Have you been Baptized?

Yes

�

Member of Episcopal Church?

Yes

�

Home Church:

�

Rector / Pastor:

�

City:

�

Diocese:

Submit Clear Form