College Outreach 2024

Please fill out the form below to enroll your student and send an $18.00 donation per student to help cover the cost of filling and mailing the care packages.

Your Student MUST be enrolled in our Young Adult Membership program to be part of Park's college outreach.

* If your student is NOT a YAM (Young Adult Member), select the second option to sign them up.

My student is already a Young Adult Member $0.00

Sign my student up as a Young Adult Member $72.00

* Student's Name

* Name of College

* Student's College Mailing Address

* Student is at the above address until the date: dd/mm/yyyy

* Student's Email

* Year in school

* Expected year of graduation

* Parent's Name

* Parent's Email

Comments

* Donation to help cover the cost filling and mailing the care packages:

$18.00

Please contact me about helping assemble the care packages

Yes, contact me

No, do not contact me

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Comments

For added Security please check the box below.

Total:

College Outreach 2024

Account Details

Payment Information

Credit Card

Checking Account

For added Security please check the box below.