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First Name
Last Name
Middle Name
Gender
Male
Female
Marital Status
Single
Married
Widowed
Divorced
Number of Children
Date of Birth
Email
Phone Number
Address 1
Address 2
Country
City
State
Zip/Postal Code
Citizenship
EDUCATION
What is your highest level of education?
No schooling completed
Nursery school to 8th grade
Some high school, no diploma
High school graduate, diploma or the equivalent (i.e. GED)
Some college credit, no degree
Trade/technical/vocational training
Associate degree
Bachelor's degree
Master's degree
Professional degree
Doctorate degree
What was your main field of study?
Please give details (provide graduation dates if applicable)
Have you attended a previous Ministry School/Seminary College/DTS? If yes, please explain.
EMPLOYMENT
Are you currently employed?
Yes
No
What industry do you have the most experience in?
How many years experience do you have in this area?
1-3 years
4-6 years
7-10 years
11-13 years
Over 13 years
N/A
Do you plan to return to this field of experience?
Yes
No
N/A
EMERGENCY CONTACT
First Name
Last Name
Relationship to You
Phone Number
Email Address
Is your father living?
Yes
No
Is your mother living?
Yes
No
HEALTH
Do you have any illnesses? If yes, please explain.
Have you received treatment for any diagnosed physical, emotional or mental conditions in the last 5 years? If yes, please explain.
Do you have any physical, emotional or mental limitations you might experience while attending Cultivate? (i.e. any undiagnosed conditions, anxiety, phobias, etc) If yes, please explain.
Do you require any special accommodations for a disability? If yes, please explain.
Medication: If you are currently on medication prescribed by a medical doctor it is our expectation that you continue with that medication during your attendance and enrollment at Cultivate and follow the advice of your doctor. If you are on medications that are mood altering we ask that you meet with our pastoral staff to discuss ways in which they support your medical plan.**
LIFESTYLE OF CONSECRATION
Answers to these questions will not necessarily disqualify you from Cultivate. We value authenticity and want to have an awareness of where you are in these areas.
Do you use tobacco? If yes, please explain.
Do you consume alcoholic beverages? If yes, please explain.
Do you use marijuana or illegal drugs? If yes, please explain.
Are you involved with/view pornography? If yes, please explain.
Are you sexually active? Singles (with anyone), marrieds (with anyone other than your spouse). We define sexually active as including intercourse, oral sex, foreplay and sexting. If yes, please explain.
Do you question your sexual or gender identity? If yes, please explain.
Do you struggle with homosexual behavior or same sex attraction? If yes, please explain.
Have you exhibited any self-destructive behavior or habitual problems within the last 2 years? (ie eating disorder, cutting, suicidal thoughts, suicidal attempts, manipulation, compulsive lying, etc.). If yes, please explain.
Have you ever been convicted of a crime? If yes, please explain.
Have you ever had a court ordered restraining order issued against you? If yes, please explain.
Have you ever been involved in the occult, witchcraft, or cults? If yes, please explain.
SPIRITUAL HISTORY
When did you accept Christ as your personal Savior?
Have you been baptized in the Holy Spirit according to Acts 1:8 and Acts 2:4?
Yes
No
What is your main denominational background?
Do you have a home church?
Yes
No
Have you recently left another church? If yes, please explain.
Please give a brief description of any other Christian service you've done.
Please give a brief description of your Christian journey.
CULTIVATE & YOU
How did you hear about Cultivate?
Briefly explain why you want to attend Cultivate.
What are you passionate about?
What is your greatest strength?
What do you hope to do with the things you learn at Cultivate?
REFERENCES
Please provide 2 personal references, 1 pastoral, and 1 from your current or previous employment.
Reference 1
Friend
Family
Pastoral
Employment
First Name
Last Name
Email Address
Phone Number
Reference 2
Friend
Family
Pastoral
Employment
First Name
Last Name
Email Address
Phone Number
Reference 3
Friend
Family
Pastoral
Employment
First Name
Last Name
Email Address
Phone Number
Reference 4
Friend
Family
Pastoral
Employment
First Name
Last Name
Email Address
Phone Number
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