Copy of Ukraine Mission Trip Application

1. Personal Information

25% of survey complete.

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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

Phone

Cell Phone

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2. If you are currently in school, please provide the following:

School Name

Your Address

City

State

Zip

Year expected to graduate

Major

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3. Where do you prefer to receive mailings?

Home Address

School Address

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4. Parish Affiliation

Parish Name and Jurisdiction

Priest Name

Parish City

Priest Phone

Parish Phone

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5. Please complete the following if your are currently employed.

Employer

Current Occupation

Employer Phone

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6. I am vaccinated for Covid-19 or will be fully vaccinated by the departure date.

Yes

Other (please specify)

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* 1. Please provide your name, address and contact information.

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* 2. If you are currently in school, please provide the following:

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* 3. Where do you prefer to receive mailings?

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* 4. Parish Affiliation

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* 5. Please complete the following if your are currently employed.

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* 6. I am vaccinated for Covid-19 or will be fully vaccinated by the departure date.

1. Please provide your name, address and contact information.

2. If you are currently in school, please provide the following:

3. Where do you prefer to receive mailings?

4. Parish Affiliation

5. Please complete the following if your are currently employed.

6. I am vaccinated for Covid-19 or will be fully vaccinated by the departure date.