Application Form

TEC Application Form
Name *

First Name Last Name
Nickname
Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone #

Area Code Phone Number
Applicant Cell # *

Area Code Phone Number
Applicant Email *
example@example.com
School
Year in School
Age *
Date of Birth *

Month Day Year
Date
Parent/Guardian 1 Name *

First Name Last Name
Parent or Guardian *

Mother Father Guardian
Language *

English Spanish English and Spanish Other
Parent/Guardian 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian 1 Phone # *

Area Code Phone Number
Parent/Guardian 1 Email *
example@example.com
Parent/Guardian 2 Name (if there is no second parent or guardian, please type N/A) *

First Name Last Name
Parent or Guardian

Mother Father Guardian
Language

English Spanish English and Spanish Other
Parent/Guardian 2 (if different than Parent/Guardian 1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian 2 Phone #

Area Code Phone Number
Parent/Guardian 2 Email
example@example.com
Parish Name *
Parish Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pastor/Minister

First Name Last Name
If you have a special patron saint or a favorite saint, please share their name with us, thank you!
Do you play an instrument? *

Yes No
If yes, which one(s)?
Do you participate in any extracurricular activities? *

Yes No
If so, which one(s)?
Do you now hold a class office or other position of leadership? *

Yes No
If so, please explain.
What are your plans after High School or College? *
What do you hope to get out of TEC? *
Has a brother, sister, or parent made a TEC? *

Yes No
If so, what is their name(s)?
Do you have any food allergies or medical concerns we should know about? *

Yes No
If so, please explain.
Reference's Name (Reference must be 21 years of age or older) *

First Name Last Name
Reference's Email *
example@example.com
Relation to Reference *
TEC is for young adults from 16-23, and candidates must be at least a junior in high school. In addition, preference will usually be given to Seniors and College age applicants because they would have less opportunity to attend in the future. Space is limited, therefore, there may be waiting lists.
Applicant Signature *

Clear
Parent/Guardian Signature *

Clear
Please send a pre-registration deposit of $10.00 to:

TEC

1206 Monroe St.

Mendota, IL 61342

This will be applied toward your total contribution of $50.00 which partially offsets the expense of your TEC weekend. This deposit is not refundable. You will be notified of the acceptance and the dates and location of your TEC. The remaining $40 will be due the first day of the weekend.
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TEC Application Form