Student Information

Student Name (Last, First, Middle Initial, Nickname):

Local Street Address 1:

Local Street Address 2:

City: State: Zip:

Local Phone (xxx-xxx-xxxx): Alternate Phone:

Email:

Birth Date (MM/DD/YYYY): Catholic: Yes: No:

Baptized: Yes: No: First Communion: Yes: No: Confirmed: Yes: No:

College: Columbia College Stephens College University of Missouri

International Student: Yes: Please List Country:

Major: Expected Date of Graduation:

Parent Information

Father's Name:

Street Address 1:

Street Address 2:

City: State: Zip:

Email:

Home Phone (xxx-xxx-xxxx): UMC Alumni: Yes: No:

Mother's Name:

Street Address Same as Above: Yes:  No:

Street Address 1:

Street Address 2:

City: State: Zip:

Email:

In celebration of the gifts received through Baptism I would like to offer to God and our faith
community my participation in the ministries of the Newman Center.

Please check all areas in which you would like to receive more information

Spirituality	Service
Catholic Theology Course	Pro-Life Group
Faith Sharing	Dorm / Greek Contact
Retreats	Newman Week
Weekly Fellowship	Service Projects / Social Justice
Scripture Study	Child Care Provider
Sacramental Sponsor	Parish Office Assistance
Eucharistic Minister	Library Volunteer
Greeter at Mass	Religious Ed (K-8)
Lector at Mass	Religious Ed High School / Life Teen Core
Mass Coordinator / Sacristan	Campus Wide Events
Music Ministry	Graphic Design
	Writing / Editing
Social	Knights of Columbus
Social Events / Activities
Intramurals
Adopt A Student