Northeast SRT 2021 Registration
Sponsored by Northeast Chi Alpha Campus Ministries
Email address *
Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
School You Attend
Degree(s) you are graduating with *
If you are not a college student, what are you doing at this time?
Check why you want to participate in the SRT *
Where are you planning to serve in the fall? *
Where are you in the application process for your mission assignment? *
If you are not associated with Chi Alpha, describe your status:
Clear selection
Please explain your status if you are in one of the two above categories:
A copy of your responses will be emailed to the address you provided.
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