Application – Refuge Discipleship School

Full Legal Name *

Name you are called by *

Relationship status *

Social media handle *

Email address *

Phone number *

Date *

T-shirt size *

Ring size *

Address *

City *

State *

Zip *

Birthday (mm/dd/yy) *

How did you hear about RDS? *

Father's name *

Phone number *

Occupation *

Accepted Christ *

Address *

Mother's name *

Phone number *

Accepted Christ *

Address *

Guardian's name

Phone number

Accepted Christ

Address

Parent Info *

Mother's Info *

Father's Info *

Who do you currently live with? *

If other, please specify

How many siblings do you have? *

Sibling names (list from oldest to youngest) *

Describe your family life *

Do you have health insurance? *

If so, who is your provider?

Emergency contact *

Emergency contact phone number *

Physician's name

Physician's phone number

How healthy are you? (1 being unhealthy, 10 being very healthy) *

Are you currently receiving medical treatment? *

Describe any physical problems or allergies that require medication or physical care

List all physical limitations/disabilities (including physical, mental, or learning)

Do you exercise? If so, how much per week? If not, why not? *

Do you presently attend church? *

Name of church

How long have you attended this church?

How many times a week do you attend this church?

Are you a member of this church?

Church denomination

Name of lead pastor

Name of youth pastor

Church address

Church phone number

Did your family attend church together

Were your parents a good spiritual role model for you?

Have you ever been baptized in water? *

When did you first accept Christ? *

When were you first born again? (mm/dd/yy) *

Do you feel a possible call to ministry? *

List the different ministries you have been involved in *

Have you ever had an Acts 2:4 experience? (not required for acceptance) *

High school (last completed year) *

Name of high school

School phone number

City/state

Year graduated

GPA

College (last completed year) *

Name of college

Job status *

Job title

Employer

Length of employment

How do you plan to pay for tuition? *

Person responsible for paying your tuition *

Address of person responsible *

Are you able to pay tuition fully at start of year? *

Do you have debt? *

Will debt prevent you from paying tuition?

Are you responsible for the care/finances of children? *

Briefly tell us your testimony *

What is your definition of a servant? *

Define your idea of ministry *

What are some qualities you feel are necessary for a spiritual leader? *

What do you plan on doing after you attend RDS? *