Life Institute Application
Name
*
First Name
Middle Name
Last Name
Preferred Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Male
Female
Social Security Number
Family Information
*
Married
Single
Dating
Engaged
Church Information
*
Name of Home Church
Pastor's Name
*
Pastor's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Specific Personal Information
What kind of involvement do you have at your church?
*
Do you regularly have devotions?
*
At this point in your life, what do you think God wants you to do?
*
Are you currently using any types of tobacco, drugs, or alcohol?
*
Have you ever been arrested?
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Yes
No
Type option 3
Type option 4
If yes, please explain the circumstances below.
If accepted, are you willing to obey the rules of Life Institute and seek to please God in all you do?
*
Yes
No
Type option 3
Type option 4
I certify that all the information above is true to the best of my knowledge.
*
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Essays
Please tell us in no less than 200 words how and when you were saved and how your salvation has affected your daily life.
*
Please tell us in no less than 200 words what your goals and expectations for life and particularly this year are. Please be as specific as possible.
*
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