Full legal name

Name you are called by

Relationship Status

Social Media Handle (platform in parentheses)

Email Address

Date

T Shirt Size T Shirt SizeX SmallSmallMediumLargeX Large2X Large3X Large

Ring Size Ring Size33.544.555.566.577.588.599.51010.51111.51212.51313.5

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

Occupation

Address

Guardian's Name

Phone Number

Accepted Christ

Occupation

Address

Parent Info Parent InfoMarriedSeperatedDivorced

Father's Info Father's InfoAliveDeceased

Mother's Info Mother's InfoAliveDeceased

Who do you currently live with? Who do you currently live with?Both ParentsFatherMotherOther

Who do you currently live with?

How many siblings do you have?

Siblings (list all brothers and sisters from oldest to youngest))

Describe your family life

Do you have health insurance?

Who is your provider?

Emergency contact

Emergency contact phone number

Physician's name

Phone

On a scale from 1-10, 1 being very unhealthy, 10 being in the best shape of my life, how would you rate yourself? On a scale from 1-10, 1 being very unhealthy, 10 being in the best shape of my life, how would you rate yourself? 12345678910

Are you currently receiving medical treatment?

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

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

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

Do you presently attend church? Do you presently attend church?YesNo

Name of the church you are attending

How long have you attended this church?

How many times a week do you attend church?

Are you a member of this church? Are you a member of this church?YesNo

Church denomination

Name of lead pastor

Name of youth pastor

Church Address

Church phone number

Did your family attend church together? Did your family attend church together?YesNo

Were your parents a good spiritual role model for you? Were your parents a good spiritual role model for you?YesNo

When did you accept Christ? (mm/yy)

Have you ever been baptized in water? Have you ever been baptized in water?YesNo

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

Do you feel a possible call to ministry? Do you feel a possible call to ministry?YesNo

Please explain

List the different ministries you have been or are currently involved in

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

High school (select last completed year) High school (select last completed year)Did not attend high school1234

Name of high school

High school phone number

City/state

Year graduated

GPA

College (select last completed year) College (select last completed year)Did not attend college1234

Name of college

Job status Job statusEmployedUnemployed

Job title

Employer

Length of employment

How do you plan to pay for tuition?

Person responsible for paying your tuition

Address of person (if not already above)

Are you able to pay fully at the start of the year? Are you able to pay fully at the start of the year?YesNo

Do you have debt? Do you have debt?YesNo

Will this prevent you from paying tuition? Will this prevent you from paying tuition? YesNo

Are you presently responsible for the care/finances of any children? Are you presently responsible for the care/finances of any children?YesNo

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 to be a spiritual leader?

What do you plan on doing after attending Refuge Discipleship School?