Student Referral

Building Disciples Together

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Thank you for responding to our request for information about students who are connected to your congregation. We'd like to get to know you and the student you're referring to us. Please share contact information in the form below. We look forward to working with you.

If you see this don't fill out this input box.

Your Name:*

Your Email:*

Your Phone Number:*

Congregation:*

Student Name: LAST

Student Name: FIRST

Student Phone Number:

Student Email Address:

Student Mailing Address (Please include zip code)

Do you know if the student is on Facebook?

Yes

Comments: Are there any other things you would like us to know about this student or their relationship to your congregation? Do you have an active adult or college age ministry in your congregation now? If so, please share information about its leadership, meeting times, etc. in the comments below as well.