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Registration Form

Personal Information:
Name:   Male   Female
Birthdate:            
Religion: Student ID:
UMR / Rolla Address:
Street: Apt / Room #
City: State: Zip:
Telephone Number: E-Mail Address:
Residence Hall: Greek Affiliation:
Year in School: Major:
International Student: Yes  NoIf yes, Country:
Home Parish: Home Diocese:
High School:
If Applicable, Spouse's Name: Number of Children:
Family Information
Father's Name: Mother's Name:
Occupation: Occupation:
Address Address
City, State, Zip: City, State, Zip:
Telephone: Telephone:
E-mail: E-mail:
Let us know how you would like to be involved and to share your gifts and time.
Faith & Spiritual Life
Retreat Planning
Retreats

Liturgy
Check if you need training
Social Justice Issues
ReignMakers Music Ministry
Please specify voice/instrument
Prayer Services
Scripture Study / Adoration / Rosary
Service and Outreach

St. Pat's Parish Ministries
Teach Religion Classes
Youth Group
Tutor Children
Mailings & Office Help
Spring Break Mission Trip
Woodcuts / Yard Work
Assist with Alumni Events
Activities with Inter-Faith Groups
Assist the Elderly
Outreach on Campus
Answer phone at Campus Ministry
Social & Sports
Social Events
Campus Activities
Hospitality
Intramural Sports
Fundraising Events
Other Comments / Questions :
   
--Your Catholic Stewardship Appeal Gifts at Work!--

Cardinal Newman Catholic Campus Ministry Center
P.O. Box 838
Rolla, MO 65402
Telephone: 573-364-2133
Fax: 573-368-3560
Email: staff@rollanewman.org