CASE Student Nomination Form

Student Information

First Name

Last Name

Date of Birth

Email Address

Cell Phone Number

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Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

High School Name

Grade level during the 2026-2027 academic year

GPA (weighted) on a 4.0 Scale

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Parent/Guardian Information
Parent/Guardian Type Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian 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
Service Organization Name Length of Participation Years Months Days 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.

CASE Student Nomination Form

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