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Home Church
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Name of Youth Leader
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First Name
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Last Name
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Cell Phone #
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Email
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Anticipated Graduation, June of (Year)
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Wisconsin/N. Michigan College(s) Applying To: Check all that apply
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Beloit College
Lawrence University
Marquette University
Michigan Tech
Northern Michigan University
Ripon College
UW Eau Claire
UW Green Bay
UW La Crosse
UW Madison
UW Milwaukee
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UW Parkside
UW Platteville
UW River Falls
UW Stevens Point
UW Stout
UW Superior
UW Whitewater
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What major(s) are you considering?
Arts (Radio, TV, Film, Music, Theater, Fine Art, Photography, etc.)
Business (Accounting, Management, Finance, etc.)
Computer Science / Technology
Engineering
English / Literature / Journalism
History
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Marketing / Graphic Design
Nursing
Political Science
Psychology
Teaching / Eduation
Sciences (Physics, Chemistry, Biology, etc.)
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