| Information About You |
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First name
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| Middle initial |
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Last name
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| Select a title |
Other: |
| Marital status |
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| Maiden name |
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| Spouse name |
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| Contact Information |
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Permanent address
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City
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| *State |
Other state or country |
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Zip
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(e.g., 53707 or 53707-7895) |
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Email
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InterVarsity may use this email to contact me about current ministry and alumni activities. |
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| Telephone |
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Is the above number your mobile phone? |
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| Alma Mater and Occupation Information |
| (please complete information about at least one campus) |
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| Campus or educational institution (1st) |
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| Educational level |
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| Major/Discipline |
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| Graduation date |
(e.g., mm/yyyy) |
| Degree |
(e.g., BA, BS, MA, etc.) |
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| Campus or educational institution (2nd) |
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| Educational level |
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| Major/Discipline |
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| Graduation date |
(e.g., mm/yyyy) |
| Degree |
(e.g., BA, BS, MA, etc.) |
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| Current occupation |
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| Ethnic Heritage |
| InterVarsity is very committed to the value of multiethnicity in ministry on campus.
To gauge our effectiveness, we ask you to indicate your ethnic background. We know
that ethnicity is not easily categorized into a short list. Please check all the
boxes which best describe yourself. |
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My ethnic heritage
(check all that apply)
Learn more about each heritage. |
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| Involvement with InterVarsity |
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Dates involved
in InterVarsity
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(e.g., 1998-2001) |
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| Primary staff worker |
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Role(s) in IV chapter, if any
(check all that apply) |
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| Urbana: year(s) |
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| Other |
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Chapter type
(check all that apply) |
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| Ethnic-specific chapter |
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| Other |
(if not above) |
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| And finally, any additional... |
| comments, feedback, unresolved issues or information requests |
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* denotes required field |
