Canvassing:

Intro Programs Application Code Book Financial Policies

Looking for Ouachita Hills College?

Application Form

Note: If you are unable to submit the application electronically, then you may mail it to:

Attn: Mr. Prewitt
PO Box A
Amity AR 71921

Instructions: Fill in all fields. Fields marked with * are required. If you do not have the information required (ie, no social security number) put "none" in the box.

IMPORTANT NOTE: The submission form is temporarily not working while we change to a new web server. If you wish to apply, please send the information requested in this form to the address above, or email Mr. Prewitt at canvassing@canvassing.org.

* First Name:
* Last Name:
Student School Phone:
* Student Email:
Social Security Number (if none, put "none"):
Citizenship:
Student's Birthdate:
Grade in School:	Please Select One: Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 College Freshman College Sophomore College Junior College Senior Graduate School Not in School

Please fill out the following information if you are under 18:

Parental Information:

Yes, my parents want me in this program. Please send my parents the necessary forms.

Fill out below only if you are under 18 or wish to have forms sent to your parents:

Father's Name:
Mother's Name:
Address, Line 1:
Address, Line 2:
City:
State:
Zip:
Country (if other than USA):
* Home Phone:
Work Phone:

I wish to apply for the following sessions:

Summer
October
Winter
February
Spring

Conference you were recruited to work in, if any:

None Kansas-Nebraska

How did you learn about the program?