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Student Name  


Gender        Birth Date (mm/dd/yy}  


Home Address      Apt.

City         State      Zip   

Home Phone #      Cell Phone




College Mailing Address      Apt/Room

City         State      Zip      On Campus Housing?

Dorm Phone #         Major         Graduating (mm/yy)

No. of Sessions Per Year    Identify Special Dietary Needs 

Approx. Final Dates for the School Year (Fall-mm/dd/yy, Spring-mm/dd/yy) 




Collegiate Ministry Contacts:  Sis. Melody Beckles and Rev. A. Craig Dunn












copyright@2003 Calvary Baptist Church