IMPACT House Check-In

Thank you for visiting the IMPACT House. Let us know who you are and what brought you here today.

Name

*

FAMU Email / TSC Email / FSU Email (Personal email if you are not a student)

*

FAMU Student ID (N/A if not a FAMU student)

*

Classification

*

Please select one option.

Freshman (1st year) Sophomore (2nd Year) Junior (3rd year) Senior (4+ year) N/A

Phone

*

How are you connected to us?

*

Please select one option.

FAMU Student FSU Student TCC Student High School Student FAMU Alumni Board of Directors Member Ministry Partner Community Member Other

If Other, please type below

Gender

*

Please select one option.

Female (Cis or Trans) Male (Cis or Trans) Non-Binary

How would you like to be identified? (Pronouns)

*

What brings you to IMPACT today?

*

Please select all that apply.

First Time Visitor Wellness Check with Pastor J Snack/Nap Break Time on the Porch Wednesday Night Gathering Worship Service Prayer Mindful Monday Movie/Game Night Chair Massage Monthly Family Meal Other

If Other, please type below

Description

Thank you for visiting the IMPACT House. Let us know who you are and what brought you here today.

Please Fix the Following

Close