Exit this survey Copy of Ukraine Mission Trip Application 1. Personal Information 25% of survey complete. Question Title * 1. Please provide your name, address and contact information. Date of Birth Name (as it will appear on passport) Home Street Address PO Box- Apt # City State Zip Email Phone Cell Phone Question Title * 2. If you are currently in school, please provide the following: School Name Your Address City State Zip Year expected to graduate Major Question Title * 3. Where do you prefer to receive mailings? Home Address School Address Question Title * 4. Parish Affiliation Parish Name and Jurisdiction Priest Name Parish City Priest Phone Parish Phone Question Title * 5. Please complete the following if your are currently employed. Employer Current Occupation Employer Phone Question Title * 6. I am vaccinated for Covid-19 or will be fully vaccinated by the departure date. Yes No Other (please specify) Next