New Student Information
We are so excited that you are here! If you're new to Student Impact and would like to get connected with our ministry, please fill out the form below!
*If you are an incoming Freshman (Class of 2024) and have received your house group placement, you do not need to fill this form out!
Sign in to Google
to save your progress.
Student Name (First & Last)
Student's Cell Phone Number:
Parent/Guardian's Name: (First & Last)
Parent/Guardian's Cell Phone Number:
Parent/Guardian's Email Address:
Address: (Street, City, Zip Code)
What High School do you attend?
What is your Graduation year?
I don't know what my house group would be
Bartlett / Elgin
Conant / Lake Park
How did you get connected with Impact?
If a friend invited you to Impact, what is their name?
Never submit passwords through Google Forms.
This form was created inside of Willowcreek.org.