College Student Questionnaire 2025-2026 • Ephrata Church of the Brethren

This form is for any young adult who is attending college, trade school, grad school, or any other type of post-secondary school program during the 2025-2026 school year! Wondering if we mean you? Just ask! Email Chris at chris@ecob.church.

Young Adult

First Name *

Last Name *

Email Address *

Mobile Number *

Person Filling out the Form

Are you the young adult who is attending one of these programs? *

Yes

What is your name?

Your Contact Info (Email or Phone #)

School Information

What school are you attending? *

What major or focus are you studying? *

Do you have a job? If so, where do you work? *

Are you involved in any sports or clubs? What are they? *

Is there anything you would like prayer for? (Job, place to live, missions, relationships, etc.) *

Contact Information

We would love to send you cards, gifts, and information of what is happening at ECOB! Please allow us the blessing of being able to do this for you by providing accurate contact information for you at school! (If you are commuting, you can provide your home contact information.)

Mailing School Name

Mailing Address *

Mailing Address Line 2

Mailing City *

Mailing State *

Mailing Zip Code *

Mailing Country *

Email Address

Cell Phone #

Tell us a little bit about YOU!

We would love to support you as best we can during this exciting time of your life. Please help us do that by providing some answers to the following questions.

Favorite Places to get Food? (Please give more than one!) *

Favorite hobby or thing to do for fun? *

Favorite candy and/or snack? *

How many roommates do you have? *

Do you have your own car with you at school? *

Yes

Do you commute to school? *

Yes

Where do you live? *

Dorm

Apartment

Home

Scholarship Opportunity

We would love to provide college students with a small scholarship for the 2025-2026 school year to be received monthly (Sept, Oct, Nov, Feb, Mar, Apr, May). We would like you to use this scholarship to do various things that would share Christ's love with those around you. You could: host your own bible study/small group with your friends and provide food for them, take someone out for coffee, give a gift to someone in need, etc. The use would be up to you. We would ask that if the person asks how you are able to provide this, you would mention ECOB in some way. Each semester we would love to hear any God moments or stories from using the scholarship money. The amount of money you can receive will be dependent on the number of students that request this scholarship.

Are you interested in receiving a scholarship to use on this kind of discipleship opportunities? *

Yes