Wufoo

Luckyday Scholar Information Form

Please fill this form out so we can have up to date information on our current scholars.

Name * First Last
Student ID Number *
Email *
Mobile Phone * - (###) - ### ####
Cellular Service Provider (i.e. Cingular) *
Campus Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
T-shirt Size

Please select your t-shirt size from the list below.
Have you started conducting service hours for this semester? *
Yes No
If so, where?

Please list the agency where you are conducting service this semester.
Please list the student organizations and activities you are involved in.
List any organizations that you would like to be involved but are not involved in at this point.
Do Not Fill This Out