Application Form

TEC Application Form
Name*

First NameLast Name
Nickname
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #

Area CodePhone Number
Applicant Cell #*

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

MonthDayYear
Date
Parent/Guardian 1 Name*

First NameLast Name
Parent or Guardian*

MotherFatherGuardian
Language*

EnglishSpanishEnglish and SpanishOther
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Phone #*

Area CodePhone 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 NameLast Name
Parent or Guardian

MotherFatherGuardian
Language

EnglishSpanishEnglish and SpanishOther
Parent/Guardian 2 (if different than Parent/Guardian 1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Phone #

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastor/Minister

First NameLast Name
What is your T-shirt size?
Do you play an instrument?*

YesNo
If yes, which one(s)?
Do you participate in any extracurricular activities?*

YesNo
If so, which one(s)?
Do you now hold a class office or other position of leadership?*

YesNo
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?*

YesNo
If so, what is their name(s)?
Do you have any food allergies or medical concerns we should know about?*

YesNo
If so, please explain.
Reference's Name (Reference must be someone 21 years or older who knows the candidate but is not a family member, such as a teacher, counselor, priest, minister, or sister. )*

First NameLast 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 sophomore 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.
Should be Empty:

TEC Application Form