Campus Outreach:

Survivors challenge the culture of death at high school and college campuses across America! 

To apply for a position on the Campus Outreach Team, please complete the following form. If anything does not apply, enter "N/A". 

 

Applicant Information
Name *
Name
Current Home Address *
Current Home Address
Mobile Phone *
Mobile Phone
Home Phone
Home Phone
All positions listed may not be availible at this time.
If accepted on which date can you join Campus Outreach?
If accepted on which date can you join Campus Outreach?
(Felony or Misdemeanor)
Please describe the crime - state nature of the crime(s), and when and where convicted and disposition of the offense.
Church Background
(Pastor, Youth Pastor, etc.)
Phone Number
Phone Number
References
Personal Reference
Personal Reference
(Friend, Family Member, Mentor, etc)
Phone Number
Phone Number
Professional Reference
Professional Reference
(Employer, Teacher, etc.)
Phone Number
Phone Number
Education Training and Experience
School Name
School Name(s)
List your degree and major
or other education
Driving Information
If so, how many?
If so, how many?
Pro-Life Experience
If you are a member of a pro-life group in your area, please complete the following:
Contact Person
Contact Person
Phone Number
Phone Number
http://
Agreements and Closing thoughts
Read the ABOUT US / WHO ARE THE SURVIVORS page