Certificate of Achievement and Service Excellence (CASE) Application

Student Information

First Name

Last Name

Date of Birth

Date of Birth

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900

Email Address

Cell Phone Number

May we send you text messages?
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May we send you text messages?
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Yes

No

Mailing Address

Mailing Address

Country

Street

City

Region

Postal Code

Grade level during the 2024-2025 academic year

JuniorSophomore

GPA (weighted)

Parent/Guardian Information
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Parent/Guardian Type FatherLegal GuardianMotherOther Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Last Email Parent/Guardian Mobile Phone Does this parent/guardian live with you? Does this parent/guardian live with you? Yes No Parent/Guardian Street Parent/Guardian City Parent/Guardian State Parent/Guardian Zip Code
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Service Experience
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Service Organization Name Length of Participation Years 12345+ Months 1234567891011 Days 1234567891011121314151617181920212223242526272829 Dates of Participation Describe this service activity.
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Short Answer

How has participation in service affected you personally?

Mercer University’s mission is to teach, to learn, to create, to discover, to inspire, to empower, and to serve. How do you connect with this message?

Final Step

I confirm the information provided on this application is accurate and truthful.