MYR Nominations Survey

1. Please note the following for nominating a student.

Please note the following for nominating a student. Student Name:
Address:
City/Town:
State:
ZIP:
Email Address:
Student Cell Number:

*

2. Home Church:

Home Church:

*

3. High School Name and Graduation Date:

High School Name and Graduation Date:

*

4. Parent/Guardian Name:

Parent/Guardian Name:

*

5. Gender:

Gender: Male

Female

*

6. Birthdate:

Birthdate:

MYR Nominations