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!
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Student Name (First & Last) *
Birthday: *
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DD
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Gender: *
Student's Cell Phone Number: *
Student's Email *
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? *
House Group *
How did you get connected with Impact? *
Required
If a friend invited you to Impact, what is their name?
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