EmailMe Form - New Jerusalem Graduating Seniors Information Form

Graduates First Name *

Graduates Last Name *

Email *

Mother's Name

Father's Name

Guardian (if applicable)

You will be receiving:

High School Diploma

College Degree

Degree in:

Military Accomplishiment

Details of Military Accomplishment

My future plans are to attend:

Name of College/University

Major

I will be attending college but undecided on what to major in at this time.

Military

I will be entering the military

Branch of Military Entering

Date of Ceremony

Time of Ceremony

Address of Ceremony (Graduation, Military, etc.)

Street Address City State / Province / Region Postal / Zip Code

New Jerusalem M. B. Church does not disclose information (personal or general) collected by our site, via our online forms. Although, we won't ever ask for your personal information like Social Security Numbers, Account Numbers, etc.

We only use information collected from our online forms to tally a count of participants for events and to contact them in case of event updates and changes, to respond to members (if the online form is specifically for members of New Jerusalem), or to share any other pertinent communication that's needed, after online form information is submitted.

Upload Photo Here

Please upload a photo of your graduate here. JPEG, PDF and Word Documents are acceptable. Thank you!