2012 Crossroads Event Application

Fields marked with an asterisk ( * ) are required.
First Name *
Middle Name
Last Name *
Street Address *
City *
State
Zip *
Home Phone *
E-mail Address *
Gender *
Date of Birth *
‘12-’13 School Year Grade Level *
What part(s) of the word do you trace your predominant ethnic heritage? (Check one or more)
Other (please specify)
Name(s) of parent(s) or legal guardian(s) *

Congregation

Congregation Name
Congregation Address
City
State
Zip
Church Phone #
Denomination
Synod (if ELCA)
Personal Hobbies, Special Interests, Activities, Organizations?
I certify that all of the information in this application is correct to the best of my knowledge. I acknowledge that for my application to be complete and considered I must submit 2 completed essay questions and 2 recommendations. I understand that I must successfully complete my current year of high school and plan to enter the next class year in the fall of 2011. If I am accepted as a TEY scholar and choose to attend, I agree to participate for the full duration of the Crossroads Event and to live by the covenant and community expectations of the Crossroads Event.

captchaimg


Can’t read the image? click here to refresh

(Please press only once)