Preliminary Form

* This information is required.

Name*

Present Address
Street*:
Street2:
City*: State*: Zip*:
Country:

Phone*

Is your present address your permanent address.

Permanent Address
Street:
Street2:
City: State: Zip:
Country:

Phone

E-Mail*

University or College

Major(s):
Graduation Date (m/d/y)

High School

City: State:
Graduation Date (m/d/y):

Your Age*:
Gender (m/f)*:

Religious Denomination*:

Marital Status*:
Single
Married
Widow
Divorced
Separated

How did you hear about RMC? (Check all that apply)
Internet Response Book Connections Book
Career Services A Friend Parish/Pastor
Campus Ministry RMC Web Site Volunteer Fair
Alternative spring break HCIH RMC Alum
Other

Placement Interests
Listed below are a variety of service opportunities. Please check off those that interest you.

Outreach to elderly Outreach to mothers and children
Hospice Therapy (Occupational, Physical, Speech)
Nursing Nurses Aid
Pastoral visitor Teacher/ Assistant
Aftercare Assistant Life Skills Assistant
Social Services Activities Coordinator Homeless shelters
Other

Please list previous volunteer experience (spring break, tutoring, long or short term, Etc.)

This preliminary application does not imply a binding obligation upon you or the Redeemer Ministry Corps. By Submitting this form you certify that the above information is true.