Apply for 2020 Residential Discipleship

Name *

Email *

Gender *

Institution

Phone

Address

Apt, suite, etc.

Country

City

State

Zip code

Please state your age if under 18 along with when you'll be turning 18.

Choose your session *

How did you hear about us? *

Please explain in a few sentences why you are interested in our program. *

Pastoral Reference *

Please give the name of a pastor whom we may contact to provide a letter of reference.

Pastoral Reference Email *

Please provide an email address for contacting your pastoral reference.

Pastoral Phone Number *

Please provide a phone number for contacting your pastoral reference.

Personal Reference *

Please give the name of a mentor whom we may contact to provide a letter of reference.

Personal Reference Email *

Please provide an email address for contacting your personal reference.

Personal Reference Phone Number *

Please provide a phone number for your personal reference.

Dietary Needs *

We are more than happy to accommodate any food allergies or preferences. In an effort to help us serve you well, please be as specific as possible. Please specify if it is an allergy or a preference and indicate the severity of your allergy. For example, if you have Celiac’s Disease, please indicate so on the form. If you are diabetic, we are happy to provide low-carb options, but again be as clear as possible with what you require. Please indicate whether cross-contamination is a problem. Our food is all prepared in the same kitchen so we cannot guarantee purity with regard to cross-contamination, but we can do our best and make informed choices on purchasing certified ingredients if necessary.

Captcha *

reCAPTCHA is required.