Group With a Leader

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* Indicates required field

Name *

First

Last

Email *

Academic major(s) *

Cell Phone Number *

Campus Mailbox Number *

Housing (Dorm & Room Number) *

Academic Year *

First Year Sophomore Junior Senior

Group leader's name, email address and phone number. *

List up to ten names and email addresses of people in your group. Groups must be all-male or all-female. Include yourself. *

If you have less than ten people, would you like Koinonia to place additional people with you to form a larger group? *

Yes No

If yes, please list characteristics or preferences of people to be placed in your group. *

Group type (check all that apply) *

Bible study Book study Service group Prayer group Special interest group/other

If you selected "special interest", please explain below. *

Additional comments *

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