Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School's Phone Number

(###)

###

####

Date of Birth *

MM

DD

YYYY

Gender *

M

F

Are you a Christian? *

Y

N

Pastor's Phone Number

(###)

###

####

Reference #1 *

First Name

Last Name

Phone

Country

(###)

###

####

Reference #2 *

First Name

Last Name

Phone

Country

(###)

###

####

Reference #3 *

First Name

Last Name

Phone

Country

(###)

###

####

Have you ever been arrested or convicted of any form of child molestation? *

Yes

No

Would you authorize a criminal background check?

Yes

No

Please check your areas of involvement for an RU Summer

Event coordinator

Program Volunteer

Religious Services Volunteer

Craft Activities Volunteer

Check all that apply to you:

Because God has blessed me to cover my expenses, I will volunteer.

I can volunteer my time, but I do need my camp housing and food furnished.

Because it is necessary for me to meet my college expenses, I hereby apply for an RU Education Scholarship.