Catholic Campus Ministry 
 
Student Information Sheet    2010-2011

Please complete this form, using the tab key to move to the next field.
(Do not hit the <enter> key - that will submit the form before it is completed.)
When completed, click on the "Submit" button at the bottom.
The form will be e-mailed to Catholic Campus Ministry.

Name           Male         Female

Address (local) (Street, City, State, Zip

E-mail Address      Telephone 

Date of Birth      I am a student at  MSU Drury U O T C S B V SJCN Select one Year Freshman Sophomore Junior Senior 5th Year Graduate Select one   Major  

Parent(s)' Name       

Address      
              Please include City, State and Zip

Parent(s)' Phone Number  

Parent(s)' E-mail         

Home Parish     City and State

Sacraments Received:      Baptism       Holy Communion       Confirmation 

There are many areas of Catholic Campus Ministry life in which you are invited to become involved.  
Please check the various items below indicating your interests.
Thank you.