2019-2020 Student Parishioner Registration Form
Each year, we ask students to register (and re-register!) as members of the University Parish Newman Center to help us serve you better!

Thank you for your presence and participation in the life of your parish community!

If you have questions about this form, please contact Jordan Cinderich at jcinderi@kent.edu
PERSONAL INFORMATION
First Name *
Your answer
Last Name *
Your answer
Phone Number
Your answer
Text Messaging
Email *
Your answer
Class of
Year
Major
Your answer
Birthdate
MM/DD/YYYY
MM
/
DD
/
YYYY
Gender
Do you live:
WHERE ARE YOU FROM?
Tell us a little about your hometown and your family.
Permanent Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Parent(s) Name(s)
Your answer
Parent(s) Phone
Your answer
Parent(s) Email
Your answer
GET INVOLVED!
Check the following option that best describes your sacramental status:
What are your interests? (check all that apply)
Submit
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