Last Name  * Email Address  * Address  * City  * State  * Zip Code  * Home Phone  * First Name  * Cell Phone  * Date of Birth (mmddyyyy)  * Year of HS Graduation   Family Background Fathers Full Name  * Mothers Full Name  * List any brothers or sisters and their ages Who are you presently living with? Father Mother Both Parents Grandparents or Relative Roomate Alone Other   Health Background Your health is Excellent Good Fair Poor List any allergies or special dietary needs List any physical limitations List any medications you are currently using Have you ever taken mood or behavior altering mediactions? Yes No List any mood or behavior altering medications you are currently taking or have taken in the past Do you currently smoke? Yes No Do you currently drink alcoholic beverages? Yes No Have you ever used illegal drugs? Yes No If yes indicate the date of last use (mmyyyy) Yes No Covered by Medical Savings or other Health Plan   Church Background Home Church  * Denomination Assemblies of GodBaptistCatholicChurch of ChristChurch of GodCongregational HolinessEpiscopalLutheranMethodistNondenominationalPentecostalPresbyterianOther Church Address  * City  * State  * Zip  * Church Phone  * Pastors Name  * Youth Pastors Name How long have you attend this church?  * List the different ministries in which you are presently involved  * Spiritual Background When did you decide to follow Christ? (include age or year)  * Have you been baptized in water? Yes No Have you experienced the baptism of the Holy Spirit? Yes No The baptism of the Holy Spirit is not a requirement. However if you have experienced the Baptism of the Holy describe your experience Describe your devotional life and current relationship with God  * How do your parents feel about you coming to Mission Georgia Masters Commission?  *   Educational Background Indicate the last level of completion 9th grade 10th grade 11th grade 12th grade/ HS graduate 1 yr college 2 yrs college 3 yrs college 4 yrs college more tha 4 year college What year did you graduate high school? What was your GPA (approximately)?   Personal & Financial Background Do you understand the financial cost for attending Mission Georgia Masters Commission? Yes No How do you plan to pay for your tuition and fees?  * Are you currently employed? Yes No List present employer Current position Number of hours per week you currently work Do you understand that Mission Georgia students will not have time to hold continuous employment including part-time jobs? Yes No Are you personally encumbered with debt? Yes No Do you plan on bringing your own automobile? (personal auto not required) Yes No If yes do you have insurance as required by Georgia law? Yes No   What interests you most about coming to Mission Georgia Masters Commission?  * If accepted are you willing to make a one year commitment to the Mission Georgia Masters Commission program? Yes No Are you aware that Mission Georgia Masters Commission does not permit first year students to date or maintain romantic relationships? Yes No How do you feel about the (No Dating) policy for first year students?  * If accepted are you willing to abide by the (No Dating) policy? Yes No Do you sense a calling into full-time or part-time ministry? Yes No If so please explain List some of your gifts talents and abilities that you would like to develop and use for Christ:  * What do you plan to do after your time at Mission Georgia Masters Commission?  *   Personal Testimony Please indicate if you have experience any of the following and include them in your written testimony Alcohol Marijuana Illegal Drugs Pornography Divorce (including parents) Physical Abuse Sexual Abuse Homosexuality/Lesbianism Eating Disorder Suicide Attempts Cult or Occult Pre-marital Sex Have you ever been arrested? Yes No Have you ever been convicted of a crime other than traffic violation? Yes No If answer is yes to one or both of the previous questions please give some details Write a brief personal testimony including some description of your life before choosing to follow Christ how you came to follow Christ and your life now as a result of deciding to follow Christ.  * Do not enter anything in this field: