Illinois Student Ministries

This form to be filled out by each Church's Teen Coordinator ONLY please!

If you are looking for the Kids Coordinator Sign Up, please use this link instead.

* indicates required

Email Address *

First Name *

Last Name *

Phone Number *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Church Name *

Church City *

Is this an Assemblies of God Church?

Yes
No
I do not know

# Students: *

# Leaders: *

Were you the Coordinator for this church last year

Yes
No