Student Application
January 2021-April 2021
Full Name
*
First Name
Last Name
Seminar Workshops
Choose one:
*
Full Time Resident, Attending All Workshops In Person
Part Time Resident, Attending Some Workshops In-person
On-line Attendance Only, All or some workshops On-line Only
Pillars of Study:
Health, Practical Bible Application, Practical Ministry, Worship, Multi-Generational Ministry & Missions
Health: Jan 21-Jan 30, 2021
Full Time Resident
Part time, In Person
On-line Only
Practical Bible Ministry: Feb 2- Feb 13, 2021
Full Time Resident
Part time, In Person
On-line Only
Practical Ministry: Feb 16- Feb 27, 2021
Full Time Resident
Part time, In Person
On-line Only
Worship: Mar 2- Mar 13, 2021
Full Time Resident
Part time, In Person
On-line Only
Multi-Generational: Mar 16- Mar 27, 2021
Full Time Resident
Part time, In Person
On-line Only
Missions: Mar 30- Apr 10, 2021
Full Time Resident
Part time, In Person
On-line Only
Basic Information
Gender
Male
Female
Current Age
*
Marital Status
*
Mailing Address
*
City, State, Zip
*
E-mail
*
Phone Number: Best one to contact you
*
-
Area Code
Phone Number
Occupation
*
Emergency Contact
*
Relationship
Phone (Emergency Contact)
*
Medical History
Do you have any medical, emotional, or mental health conditions?
No
Yes
If yes, please describe:
Do you take any medications?
Yes
No
If yes, please list medication, reason and any side effects:
Have you had any serious illness, injuries, or medical operations in the last three years?
Yes
No
If yes, please list:
Have you had any physical handicaps or conditions preventing you from performing any type of activity?
No
Yes
If yes, please list:
Do you have any allergies, of any kind?
No
Yes
If yes, please list:
Education
Check Highest Level of Education
Elementary
Middle/Jr. High
High School
Some College
College Degree
Personal Profile
Have you committed your life to Jesus Christ?
No
Yes
Where & When:
What church do you presently attend?
*
For how long?
Pastor's Name
*
List three (3) strengths you have: Please be specific
*
List three (3) weaknesses you have: Please be specific
*
I hereby release any individual, church, ministry, charity, reference, or any other person or organization, both collectively and individually from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.
Yes
No
I hereby give permission to release any photos or videos of me while participating in any part of the workshops, classes or field trips relating to Native American Coalition.
Yes
No
I have carefully read the foregoing release and know the contents thereof and I sign this release of my own free act. This is a legally binding agreement which I have read and understand.
Yes
No
Thank you for your interest in being a part of the Native American Coalition!
By submitting this form you give us permission to begin the screening process.
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