Campus Ministry Connection
Information on this form will be used to connect young adults to campus ministries. If you are submitting information on behalf of someone else, we assume you have received their knowledge/consent to share this information.
Who is submitting the young adult referral?
Please Select
Congregation Staff Person
Priest
Parent
Young Adult
Youth Leader
Referring church:
Email of the person who is filling out the form:
*
Young Adult's Information
Young Adult's Phone Number:
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Area Code
Phone Number
Young Adult's Email
*
College/University:
Please Select
Austin Peay State University
Belmont University
Fisk University
Lipscomb University
Meharry Medical College
Middle Tennessee State University
Tennessee State University
Tennessee Tech University
Anticipated College Start Date:
-
Month
-
Day
Year
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Any additional helpful information (can be specific interests, field of study, areas of concern, etc.)
Submit
Should be Empty: