Stevensville United Methodist Church

Secret Saint Application

Student Information

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Name * required


First Name	Last Name

Birthdate * required

College Year * select one

Select one

Freshman
Sophmore
Junior
Senior
Post-Grad/5th Year

Major Area of Study: required

Email * required

Email Address

College Address *


Address

Address Line 2

City	State	Zip Code

During the school year I will be living: * select one

Select one

On Campus
Off Campus

I will have access to * select one

Select all that apply

A refrigerator
A stove
A microwave

Parent's Names * required


First Name	Last Name

Parent's Address:


Address

Address Line 2

City	State	Zip Code

Parent's E-Mail Address required

Email Address

When do you leave for school? required

Click in box to select date

When do you plan to return home for the summer? required

Click in box to select date

Mid-term exams are in the months of: required

Final Exams are in the months of: required

Dates of Christmas vacation: required

Dates of spring vacation: required

Other holidays you plan to be home: select one

Select all that apply

Halloween
Thanksgiving
Valentine's Day
Easter

Student Favorites

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My favorite type of cookie is... select one

Select all that apply

Chocolate Chip
Peanut Butter
Oatmeal Raisin
Other (use free space at end of form to let us know!)

My favorite type of candy bar is... select one

Select all that apply

Snickers
Kit Kat
Reese's
Other (use free space at end of form to let us know!)

My favorite type of hard candy is... select one

Select all that apply

Life Savers
Peppermints
Suckers
Other (use free space at end of form to let us know!)

My favorite type of snack food is... select one

Select all that apply

Popcorn
Chips
Peanuts
Other (use free space at end of form to let us know!)

My favorite type of cereal is... select one

Select all that apply

Captain Crunch
Golden Grahams
Lucky Charms
Other (use free space at end of form to let us know!)

My favorite fast food restaurant is... select one

Select all that apply

McDonald's
Burger King
Taco Bell
Other (use free space at end of form to let us know!)

My favorite pizza place is... select one

Select all that apply

Pizza Hut
Domino's
Papa John's
Other (use free space at end of form to let us know!)

My favorite place to shop is... select one

Select all that apply

Target
Walmart
Meijer
Other (use free space at end of form to let us know!)

My favorite thing to do in my spare time is... select one

Select all that apply

Watch Movies
Read
Exercise
Other (use free space at end of form to let us know!)

I am a member of select one

Select all that apply

a sports team
the band
a club
Other (use free space at end of form to let us know!)

Please use the space to tell your Secret Saint anything else about yourself. Be specific - your answers will help them know what to send in your care packages. required

* required

This form is generated and maintained by Stevensville United Methodist Church.
For refund and privacy policies please contact Stevensville United Methodist Church at www.stevensvilleumc.org.