Messiah College: Parents Council

Prospective Membership Survey

Name(s):

Address:

Street/Road

City

State

Zip

Phone:

(Day/Business)

(Evening/Home)

Email Address:

Occupation:

Degrees and/or Certifications:

Name of son(s) and/or daughter(s) attending Messiah:

Anticipated year of graduation:

Current Major:

Briefly describe your interest in serving on the Parents Council:

Briefly describe your church affiliation
and involvements:

The Parents Council meets twice a year; during Family Weekend in September, and usually in early April. The meetings are normally scheduled Friday afternoon and Saturday morning. Will you be able to commit to attending these meetings?

Yes
No
Unsure
Need More Information

Need More Information Unsure No Yes

Briefly describe what you believe to be some of the essentials for effective Christian education:

What contributions would you like to make to Messiah College through Parents Council involvement?:

Can you endorse and support our Mission and Identity Statements and Statements of Faith?

Yes
No

Additional Comments:

Signature(s):

If you are filling out this form, please type your full name with date included in the boxes below:

Full Name

Date

Full Name

Date