Radical Life Application Form

Radical Life Application

Application Deadline - May 25 , 2017
AGORA Ministries

1807 San Fernando
San Antonio Tx, 78207 info@agoraministries.com
Thank you for your interest in our Radical Life Discipleship program! It is our intention that the application process serve as a valuable tool in helping you, your church and us in AGORA, prayerfully evaluate whether this is the right course for you at this time.

We pray that God will guide you clearly as you complete this form.
Read and follow the instructions carefully prior to submitting your application. This application will be considered only when all of the items listed below are received by the Personnel Office of AGORA Ministries.
- Complete the application: The information requested on this form is to details relevant to our consideration of your application.
- Medical: Please indclude all relevant medical information to the best of your knowledge.
- 3 Reference Forms completed by
a) Your Pastor

b) A Christian Friend who has known you for longer than 2 years.

c) Your Employer or Spiritual Leader.

Please use proper spelling, capitalization and punctuation.
- Sign and complete the Application
There will be multiple file upload links available. Please provide the oppropriate required infromation or email seperately to info@agoraministries.com in one concise email so that we can keep all of your information together.
Photo Upload Photograph – one recent picture of yourself (Upload photo or email separately with references)

Upload a File

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Yes, I have
I. Personal Data:

Tell us about yourself
Full Name*

First NameMiddle NameLast NameSuffix
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
MaleFemale
SingleMarriedDivorced
Name of Spouse

First NameLast Name
Name of Child (if any)

First NameLast Name
Name of Child (if any)

First NameLast Name
Home Church*
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pastors Name*
Pastors Phone Number*

Area CodePhone Number
Denomination
How long have you attended this church?*
How long have you been a born again Christian?*
Any previous ministry experience? If so, when and where?*

0/300
What is your highest level of education completed?*
Musical Abilities?
Other Talents?
What are your plans after you complete Radical Life Discipleship?*
YesNo
If No, what percentage do you have? and from what sources will you receive the remainder?*
II. Emergency Contact:
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
III. Christian Life:

Please answer the following as fully as possible
1. Please describe in some detail your experience with God (your circumstances before becoming a Christian, your conversion experience...)*
2. Summarize your relationship with God at present.*
3. Describe your relationship with your local church; include areas of worship and leadership. How are you involved? How does your church leadership feel about you getting involved with AGORA?*
4. Have you had any missions experiences? If so, where and what type(s) of ministry were you involved in?*
5. Are there any skills or talents that you are working to develop at present (ex. Music, sport, art, languages, etc…)*
6. Have you ever been involved in felonious crime, drug or alcohol abuse, occult activities, or homosexual practices? Explain.*
8. In describing yourself, what would you say are your strengths and weaknesses?*
9. What areas of your character are you presently seeking God to further develop and improve?*
10. How would you describe your relationship with your family and Is there anything about your family relationships that you would like us to be aware of?*
11. How did you hear about AGORA?*
12. Why do you desire to attend this school?*
13. Please list any special circumstances or situations we should know about.
IV. References Information:
Please provide or email to info@agoraministries.com a reference letter from each of the following:
1. Pastor
2. Friend (known longer than two years)
3. Employer or Spiritual Leader
Include the answers to the following questions

a. How long have you known the applicant?

b. What is your relationship with the applicant?

c. According to you what are their strengths and weaknesses.

d. How active is the applicant in serving in the church/missions/volunteering/community service?

e. Please give a brief description of their character
V. Medical and Medications Instructions
If you are bringing any medication, please list below the type of medication and the schedule to be followed for administering the medication. (Please include a copy of the instructions with the student’s prescription in a ziploc bag, along with a copy of your insurance card. Each participant is required to have individual medical insraurance.)
Please list the name and type of each medication and please give instructions on how each medication should be given:
Are there any side effects to watch for? If so, please describe:
Are you aware of allergies your may have? If so, what are they and what is the reaction:
Do you have any medical problems we need to be made aware of:
Are there any activities that you should not participate in because of a medical need:
Additional Medical Info

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VI. Parental Consent
Name of Parent/ Guardian

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
VII. Insurance Provider
Insurance Provider
Insurance phone number

Area CodePhone Number
Policy/ID number
Group Name
Group Number
VIII. Applicant's E-Signature
I certify that all information in this application is complete and accurate. If accepted by AGORA Ministries, I will abide by the spirit, rules, and schedule of the program. In accordance with Biblical principles, I agree to resolve any and all disputes with AGORA Ministries, AGORA Directors, or staff by means of reconciliation or mediation, and waive any right to pursue action by way of litigation. I confirm that I understand that payment of the required school tuition fee must be made upon or before the deadline set by the Director. I also confirm that I am fully aware of my financial obligation, both to the Lord and to the students and staff at the ministry. I therefore commit myself to paying all personal expenses incurred during my involvement with AGORA Ministries.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Radical Life Application

I. Personal Data:

II. Emergency Contact:

III. Christian Life:

IV. References Information:

V. Medical and Medications Instructions

VI. Parental Consent

VII. Insurance Provider

VIII. Applicant's E-Signature