What activities have you been involved with at your high school?

Student Council
Athletic Team
National Honor Society
Environmental Club
Fellowship of Christian Athletes
Bible Club
Service Organization
Mentoring Club
Other:
Other:
Other:

What activities have you been involved with at your church?

Not Applicable
Sunday School
Youth Group
Youth Choir
Youth Praise Team
Mission Trip
Leadership Team
Other:
Other:
Other:

What activities have you been involved with in your community?

Service Organization:
Big Brothers / Big Sisters
Other:
Other:
Other:

Please list your honors and awards:

Briefly, what would you like to be doing after college?

If you are interested in a particular Service Learning program, which one (pick all that apply)?

Discipleship Southwestern
Green Team Southwestern
Leadership Southwestern

Do you have a specific question about one of our Service Learning programs?

Name:
Address:
City:
State:
Zip:
Email Address:
Cell Phone:
Home Phone:
High School GPA:
Potential Major, if known:
Have you made a campus visit?:	Yes No
Would you like to visit campus?:	Yes No