College Student Contact information
The Peninsula Delaware Conference Board of Higher Education and Campus Ministry will use this information for the sole purpose of connecting a student with a local United Methodist Campus Ministry within the bounds of our annual conference and beyond. This information will ONLY be shared with a campus pastor or local UM clergy person for the purpose of outreach. Information will only be used and shared if permission has been granted by the parent or legal guardian of students, as indicated at the bottom of this survey.
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Email *
Your Name *
Your Church *
Your Role in the Church
Your Relationship to the Student
Student Name
Student Address *
Student Email Address
Best Way to Contact Student
Comments
I have the permission of the student and/or their legal guardian to share this personal information with the Conference Board of Higher Education and Campus Ministry and other relevant ministries at their discretion. *
Required
A copy of your responses will be emailed to the address you provided.
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