Application – CORE Evangelism

APPLICATION SECTION

First Name *

Last Name *

Address Number & Street

City/Town

State, ZIP Code

Home Phone

Cell Phone *

Email *

Current School

EMERGENCY CONTACT

First Name *

Last Name *

Address Number & Street

City/Town

State, ZIP Code

Home Phone

Cell Phone *

Relationship *

Email *

PERSONAL INFORMATION

Gender *

Male
Female

Date of Birth

Language *

English is my first language
English is my second language

Additional Language

Do you have health insurance?

Who is you health insurance provider?

Are you bringing a vehicle?

Have you ever been dismissed from any educational institution?

If yes, please explain

PAST EDUCATION

Please describe your past education (hight school and above):

Year Attended

Grade Levels

School Attended

Degree/Certificate

2022-2023

Year Attended 1

Grade Levels 1

School Attended 1

2021-2022

Year Attended 2

Grade Levels 2

School Attended 2

2020-2021

Year Attended 3

Grade Levels 3

School Attended 3

2019-2020

Year Attended 4

Grade Levels 4

School Attended 4

QUESTIONNAIRE

How did you hear about CORE? *

What are some of your hobbies and pastimes? *

Share some of your favorite authors and why you like them

Describe your understanding of the third angel’s message (Revelation 14) as it pertains to us today (leave blank if you are not sure)

What talents and abilities do you already have that you could bring to CORE and our ministry outreach? *

ABOUT YOU

Do you understand the fundamental beliefs and practices of the Seventh-day Adventist Church? *

Are you in agreement with them? *

If not please explain why

Are you a baptized member of the Seventh-day Adventist Church?

Baptismal Date

Local Church

Name of Pastor

Pastor’s Phone

Describe how you came to know Jesus

How are you growing in Jesus?

What would you say are some the biggest challenges/issues facing teenage boys and girls of this generation?

What are three of your personal goals for the next 2-3 years?

Goal 1 *

Goal 2 *

Goal 3 *

When I graduate from CORE, I would like to...

MEDICAL HISTORY

It is very important that the following questions be answered as accurately as possible. If you have any questions regarding any of them feel free to call our office for any clarification.

Do you have or have you had any significant physical conditions or special limitations (climate, diet, exercise, stamina, eating disorder, depression, prescription medication)?

If Yes, please explain. (When? For how long? Is this a current condition? If not, when did it end?) Also include the name and phone number of your attending physician.

If Yes, please explain.

Have you ever seen a counselor or therapist for any reason (including addiction)?

If Yes, when and for what?

LEGAL RECORDS

Have you ever had an arrest for any violation that resulted in a conviction, a plea of guilty, or no contest, probation, community service, a summary report, or some other form of adjudication (other than a minor traffic violation)?

If Yes, please explain.

Do you have any pending charges or are you under any type of legal investigation?

If Yes, please explain.

Have you ever been accused of any kind of abusive behavior?

If yes, please explain.

REFRENCES

Three reference forms should be completed and submitted directly by the reference to complete your application. References cannot be friends or family. They should be professional, educational, or spiritual leaders/supervisors in your life who can speak to your spiritual, professional, and educational maturity. They should have at least 6 months of experience in working with you. A working phone number must be provided for each reference.

Signature

By my signature, I certify that the statements and information furnished by the undersigned in this application form are true and complete. I agree my electronic signature and initials shall have the same force as my written signature or initial.

Applicant Signature *

Applicant Signature

Date 1 *