FALL 2020 ROOTED WAITLIST

NAME

First Name

Last Name

BIRTHDATE

MARITAL STATUS

SINGLE

MARRIED

EMAIL

PHONE

(###)

###

####

GROUP MEETING DAY

SUNDAY AFTERNOON ON-CAMPUS

MONDAY ON ZOOM

TUESDAY ON ZOOM

TUESDAY ON-CAMPUS

I WANT TO BE A PART OF

ROOTED ON-CAMPUS

ROOTED ON ZOOM

EITHER

FACILITATOR REQUEST

IS THERE SOMEONE YOU WANT TO BE IN YOUR ZOOM GROUP?